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*
Lane Raymond J.

(Last) (First) (Middle)
C/O BEYOND MEAT, INC.
119 STANDARD STREET

(Street)
EL SEGUNDO CA 90245

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/01/2019
3. Issuer Name and Ticker or Trading Symbol
BEYOND MEAT, INC. [ BYND ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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)
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
Series E Convertible Preferred Stock (1) (1) Common Stock 54,348 (1) I(2) By GreatPoint Ventures Innovation Fund, LP.
Series F Convertible Preferred Stock (1) (1) Common Stock 48,505 (1) I(2) By GreatPoint Ventures Innovation Fund, LP.
Series H Convertible Preferred Stock (1) (1) Common Stock 119,317 (1) I(2) By GreatPoint Ventures Innovation Fund LP
Series H Convertible Preferred Stock (1) (1) Common Stock 4,496 (1) I(3) By GreatPoint Ventures Innovation Parellel Fund LP
Explanation of Responses:
1. Shares of preferred stock will automatically convert into shares of common stock on a 1-to-1 basis upon closing of the Issuer's initial public offering. The preferred stock has no expiration date.
2. As a member of the investment committee of GreatPoint Ventures Innovation Fund, LP.("GVIF"), the Reporting Person may be deemed to share voting and dispositive powers with other members of the GVIF committee.
3. As a member of the investment committee of GreatPoint Ventures Innovation Parallel Fund, LP. ("GVIPF"), the Reporting Person may be deemed to share voting and dispositive powers with other members of the GVIPF committee.
Remarks:
Ex. 24 Power of Attorney attached.
/s/ Mark J. Nelson, as Attorney-In-Fact for Raymond J Lane 05/01/2019
** 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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