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*
Hillsven LLC

(Last) (First) (Middle)
THREE LAGOON DR., SUITE 400

(Street)
REDWOOD CITY CA 94065

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/09/2021
3. Issuer Name and Ticker or Trading Symbol
Expensify, Inc. [ [EXFY] ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 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)
Form filed by One Reporting Person
X 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 A Convertible Preferred Stock (1) (1) Class A Common Stock 6,659,530(1) (1) D(2)
Series B Convertible Preferred Stock (1) (1) Class A Common Stock 3,270,280(1) (1) D(2)
Series B-1 Convertible Preferred Stock (1) (1) Class A Common Stock 487,100(1) (1) D(2)
Series C Convertible Preferred Stock (1) (1) Class A Common Stock 731,410(1) (1) D(2)
1. Name and Address of Reporting Person*
Hillsven LLC

(Last) (First) (Middle)
THREE LAGOON DR., SUITE 400

(Street)
REDWOOD CITY CA 94065

(City) (State) (Zip)
1. Name and Address of Reporting Person*
FBHR Associates LLC

(Last) (First) (Middle)
THREE LAGOON DR., SUITE 400

(Street)
REDWOOD CITY CA 94065

(City) (State) (Zip)
1. Name and Address of Reporting Person*
DeMartini James G B III

(Last) (First) (Middle)
THREE LAGOON DR., SUITE 400

(Street)
REDWOOD CITY CA 94065

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Unameit Trust under Declaration of Trust dated March 10, 2000

(Last) (First) (Middle)
THREE LAGOON DR., SUITE 400

(Street)
REDWOOD CITY CA 94065

(City) (State) (Zip)
Explanation of Responses:
1. Each share of Convertible Preferred Stock was initially convertible on a one-for-one basis into the Issuer's Class A Common Stock at any time at the holder's election and has no expiration date. The number of underlying shares of common stock reported in Column 3 gives effect to a 10-for-1 forward stock split effective as of October 27, 2021, pursuant to which each share of Convertible Preferred Stock became convertible into 10 shares of Class A Common Stock. The Convertible Preferred Stock will convert automatically upon closing of the Issuer's initial public offering.
2. FBHR Associates, LLC is the manager of Hillsven, LLC and in such capacity may be deemed to share voting and investment power over such securities. James G.B. DeMartini, III, as trustee of Unameit Trust, is the manager of FBHR Associates, LLC, and in such capacity may be deemed to share voting and investment power over such securities.
Remarks:
/s/ James G.B. DeMartini, III, Managing Member of Hillsven LLC 11/09/2021
/s/ James G.B. DeMartini, III, trustee of Unameit Trust, Managing Member of FBHR Associates LLC 11/09/2021
/s/ James G.B. DeMartini, III, trustee of Unameit Trust 11/09/2021
/s/ James G.B. DeMartini, III 11/09/2021
** 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).
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