SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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1. Name and Address of Reporting Person*
Dent Claudia

(Last) (First) (Middle)
C/O EVERBRIDGE, INC.
25 CORPORATE DRIVE, SUITE 400

(Street)
BURLINGTON MA 01803

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/14/2016
3. Issuer Name and Ticker or Trading Symbol
EVERBRIDGE, INC. [ EVBG ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
SVP Product Management
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 19,565 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) (1) 08/28/2022 Common Stock 32,608 1.32 D
Stock Option (Right to Buy) 05/08/2014(2) 05/07/2024 Common Stock 8,696 7.02 D
Stock Option (Right to Buy) 07/15/2015(3) 07/14/2025 Common Stock 1,740 13.63 D
Stock Option (Right to Buy) 11/14/2016(4) 11/13/2026 Common Stock 15,000 14.89 D
Explanation of Responses:
1. This stock option is fully vested and exercisable.
2. 25% of the shares originally subject to the Stock Option vested and became exercisable on May 8, 2016, and the remaining shares vest in 12 equal quarterly installments thereafter.
3. 25% of the shares subject to the Stock Option vested and became exercisable on July 15, 2016, and the remaining shares will vest in 12 equal quarterly installments thereafter.
4. 25% of the shares subject to the Stock Option will vest and become exercisable on November 14, 2017, and the remaining shares will vest in 12 equal quarterly installments thereafter.
/s/ Elliot J. Mark, Attorney-in-Fact 11/22/2016
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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