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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 07/27/2021 | 3. Issuer Name and Ticker or Trading Symbol MeridianLink, Inc. [ MLNK ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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, par value $0.001 | 133,347 | D | |
Common Stock, par value $0.001 | 39,958 | I | See Footnote(1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 (option to buy) | (2) | 10/09/2029 | Common Stock, par value $0.001 | 2,325,000 | 6.0607 | D |
Explanation of Responses: |
1. The shares are held directly by the Vlok Family Trust, dated March 17, 2009. The reporting person and his spouse are the co-trustees of the Vlok Family Trust, dated March 17, 2009 and share sole voting and dispositive power with respect to all securities held by such entity. The reporting person may be deemed to be the beneficial owner of the securities held by the Vlok Family Trust, dated March 17, 2009. |
2. With respect to (i) 912,500 of the shares underlying the option, one third of such shares vested on September 1, 2020, and the remaining two thirds of such shares vest in 24 equal monthly instalments thereafter, in each case subject to the reporting person's continued service through the applicable vesting date, (ii) 912,500 of the shares underlying this option are scheduled to vest based upon the Company's level of achievement of a predetermined EBITDA metric, and (iii) 500,000 of the shares underlying this option vested immediately prior to the effectiveness of the Company's registration statement filed on form S-1 for its initial public offering. In addition, 100% of the then-unvested shares subject to this award vest immediately prior to the sale of the company, subject to the reporting person's continued service through such date. |
Remarks: |
Exhibit 24 - Power of Attorney |
/s/ Kayla Dailey, as attorney-in-fact | 07/27/2021 | |
** 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. | ||
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 Number. |