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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| 101 S. ELLSWORTH AVENUE |
| SUITE 401 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
07/16/2015
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3. Issuer Name and Ticker or Trading Symbol
OOMA INC
[ OOMA ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
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| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Stock |
25,000 |
D |
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Stock Option (right to buy) |
|
02/21/2025 |
Common Stock |
10,000 |
9.18 |
D |
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| Explanation of Responses: |
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| Remarks: |
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/s/ James N. Strawbridge, as attorney-in-fact for Peter J. Goettner |
07/16/2015 |
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** 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. |
POWER OF ATTORNEY
The undersigned individual (the "Reporting Person") hereby authorizes and
designates Worldview Equity I, L.L.C., or such other person or entity as is
designated in writing by James Strawbridge (the "Designated Filer") as the
beneficial owner to prepare and file on behalf of the Reporting Person
individually, or jointly together with the any other reporting persons, any and
all reports, notices, communications and other documents (including, but not
limited to, reports on Schedule 13D, Schedule 13G, Form 13H, Form 13-F, Form 3,
Form 4 and Form 5) that the Reporting Person may be required to file with the
United States Securities and Exchange Commission pursuant to the Securities Act
of 1933, as amended (together with the implementing regulations thereto, the
"Act") and the Securities Exchange Act of 1934, as amended (together with the
implementing regulations thereto, the "Exchange Act") (collectively, the
"Reports") with respect to the Reporting Person's ownership of, or transactions
in, securities of any entity whose securities are beneficially owned (directly
or indirectly) by the Reporting Person (collectively, the "Companies").
The Reporting Person hereby further authorizes and designates each of James
Strawbridge, Daniel Dumais and Michael Orsak (each an "Authorized Signatory") as
his true and lawful attorney-in-fact to execute and file on behalf of the
Reporting Person the Reports and to perform any and all other acts, which in the
opinion of the Designated Filer or Authorized Signatory may be necessary or
incidental to the performance of the foregoing powers herein granted.
The authority of the Designated Filer and each Authorized Signatory under this
Power of Attorney with respect to the Reporting Person shall continue until the
Reporting Person is no longer required to file any Reports with respect to the
Reporting Person's ownership of, or transactions in, the securities of the
Companies, unless earlier revoked in writing. The Reporting Person acknowledges
that the Designated Filer and each Authorized Signatory are not assuming any of
the Reporting Person's responsibilities to comply with the Act, the Exchange Act
or any other applicable law.
July 15, 2015
_/s/ Peter J. Goettner ________________
Peter J. Goettner
