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*
3000 SAND HILL ROAD, 4-250 |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 07/19/2012
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3. Issuer Name and Ticker or Trading Symbol
Palo Alto Networks Inc
[ PANW ]
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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 |
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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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 |
Series C Preferred Stock |
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Common Stock |
16,150 |
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I |
By Sequoia Capital Growth Partners III, LP
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Series C Preferred Stock |
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Common Stock |
76,202 |
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I |
By Sequoia Capital Growth III Principals Fund, LLC
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Series C Preferred Stock |
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Common Stock |
1,475,592 |
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I |
By Sequoia Capital Growth Fund III, LP
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Series A-1 Preferred Stock |
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Common Stock |
6,690 |
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I |
By Sequoia Technology Partners XI, LP
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Series A-1 Preferred Stock |
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Common Stock |
23,038 |
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I |
By Sequoia Capital XI Principals Fund, LLC
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Series A-1 Preferred Stock |
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Common Stock |
211,772 |
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I |
By Sequoia Capital XI, LP
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Series A-2 Preferred Stock |
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Common Stock |
242,600 |
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I |
By Sequoia Technology Partners XI, LP
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Series A-2 Preferred Stock |
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Common Stock |
835,528 |
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I |
By Sequoia Capital XI Principals Fund, LLC
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Series A-2 Preferred Stock |
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Common Stock |
7,680,022 |
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I |
By Sequoia Capital XI, LP
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Series B Preferred Stock |
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Common Stock |
66,089 |
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I |
By Sequoia Technology Partners XI, LP
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Series B Preferred Stock |
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Common Stock |
227,612 |
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I |
By Sequoia Capital XI Principals Fund, LLC
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Series B Preferred Stock |
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Common Stock |
2,092,167 |
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I |
By Sequoia Capital XI, LP
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Series C Preferred Stock |
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Common Stock |
20,017 |
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I |
By Sequoia Technology Partners XI, LP
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Series C Preferred Stock |
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Common Stock |
68,938 |
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I |
By Sequoia Capital XI Principals Fund, LLC
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Series C Preferred Stock |
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Common Stock |
633,669 |
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I |
By Sequoia Capital XI, LP
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Explanation of Responses: |
Remarks: |
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/s/ Melinda Dunn, by power of attorney for James J. Goetz |
07/19/2012 |
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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. |
rrd315259_356165.html
LIMITED POWER OF ATTORNEY
FOR
SECTION 16(a) FILINGS
Know all by these presents, that the undersigned hereby constitutes and
appoints Melinda Dunn the undersigned's true and lawful attorney-in-fact to:
(1) Execute for and on behalf of the undersigned, in the
undersigned's capacity as an officer, director and/or
stockholder of any corporation or other person in which an
investment fund affiliated with Sequoia Capital Operations, LLC
makes an investment (each, a "Company"), Forms 3, 4, and 5 and
amendments thereto in accordance with Section 16(a) of the
Securities Exchange Act of 1934 and the rules thereunder;
(2) Do and perform any and all acts for and on behalf of the
undersigned which may be necessary or desirable to complete and
execute any such Form 3, 4, or 5 or amendment thereto and timely
file such form with the United States Securities and Exchange
Commission (the "SEC") and any stock exchange or similar
authority; and
(3) Take any other action of any type whatsoever which, in the
opinion of such attorney-in-fact, may be necessary or desirable
in connection with the foregoing authority, it being understood
that the documents executed by such attorney-in-fact on behalf
of the undersigned pursuant to this Limited Power of Attorney
shall be in such form and shall contain such terms and
conditions as such attorney-in-fact may approve.
The undersigned hereby grants to such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever required,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Limited Power of Attorney and the rights and powers
herein granted. The undersigned acknowledges that the foregoing
attorney-in-fact, in serving in such capacity at the request of the undersigned,
is not assuming, nor is any Company assuming, any of the undersigned's
responsibilities to comply with Section 16 of the Securities Exchange Act of
1934.
This Limited Power of Attorney shall remain in full force and effect
until the undersigned is no longer required to file Forms 3, 4, and 5 with
respect to any Company, unless earlier revoked by the undersigned in a signed
writing delivered to the foregoing attorney-in-fact. This Limited Power of
Attorney may be filed with the SEC as a confirming statement of the authority
granted herein.
[Signature Page Follows]
IN WITNESS WHEREOF, the undersigned has caused this Limited Power of
Attorney to be executed as of this 24th day of August, 2009.
/s/ James J. Goetz
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Name: James J. Goetz