UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Option (right to buy) | Â (2) | 12/16/2020 | Common Stock | 94,881 | $ 5.8 | D | Â |
Employee Stock Option (right to buy) | Â (3) | 02/09/2021 | Common Stock | 20,000 | $ 6.2 | D | Â |
Employee Stock Option (right to buy) | Â (4) | 12/21/2022 | Common Stock | 20,000 | $ 5.82 | D | Â |
Employee Stock Option (right to buy) | Â (5) | 02/07/2022 | Common Stock | 4,424 | $ 6.03 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Johnson Ashley F. C/O SERVICESOURCE INTERNATIONAL, INC. 634 SECOND STREET SAN FRANCISCO, CA 94107 |
 |  |  Chief Financial Officer |  |
/s/ Paul D. Warenski, by power of attorney | 03/28/2013 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Includes 115,000 shares represented by restricted stock units ("RSUs") pursuant to which 5,000 shares vest in three equal annual installments beginning on February 7, 2014 and 25,000 shares vest in four equal annual installments beginning on December 21, 2013. |
(2) | An option to purchase 120,000 shares was granted on December 16, 2010 and was exercised in part prior to the date on which the Reporting Person became subject to Section 16. One-fourth of the shares vested on September 29, 2011 and 1/48th of the shares vest monthly thereafter. |
(3) | One-fourth of the shares vested on January 1, 2012 and 1/48th of the shares vest monthly thereafter. |
(4) | One-fourth of the shares vested on December 21, 2013 and 1/48th of the shares vest monthly thereafter. |
(5) | One-fourth of the shares vested on February 7, 2013 and 1/48th of the shares vest monthly thereafter. |
 Remarks: Exhibit 24 - Power of Attorney |