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*
| 280 PARK AVENUE, 3RD FLOOR |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
07/30/2014
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3. Issuer Name and Ticker or Trading Symbol
HEALTHEQUITY INC
[ HQY ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
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)
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Form filed by One Reporting Person |
| X |
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 |
728,000 |
D |
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| Common Stock |
728,000 |
I |
See footnote
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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 D-3 Preferred Stock |
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Common Stock |
3,303,468 |
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D |
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| Series D-3 Preferred Stock |
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Common Stock |
3,303,468 |
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I |
See footnote
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1. Name and Address of Reporting Person*
| 280 PARK AVENUE, 3RD FLOOR |
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(Street)
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1. Name and Address of Reporting Person*
| 280 PARK AVENUE, 3RD FLOOR |
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(Street)
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| Explanation of Responses: |
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| Remarks: |
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FINANCIAL PARTNERS FUND I, L.P., By: NAPIER PARK GLOBAL CAPITAL GP LLC, its general partner, By: /s/ Manu Rana |
07/30/2014 |
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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. |
(5) All securities are held of record by Financial Partners Fund I, L.P. (“FPF I”), a Delaware limited partnership. Napier Park Global Capital GP LLC, a Delaware limited liability company (“Napier Park”) is the general partner of FPF I and as such all securities held by FPF I may be deemed attributable to Napier Park. Manu Rana and Steven Piaker are the managing principals of FPF I. The foregoing is not an admission by Napier Park that it is the beneficial owner of the securities held of record by FPF I. Each of Messrs. Rana and Piaker disclaims beneficial ownership of the securities held by FPF I.
JOINT FILERS’ NAMES AND ADDRESSES
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1.
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Napier Park Global Capital GP LLC
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The business address for the above reporting persons is:
280 Park Avenue, 3rd Floor
New York, N.Y. 10017
JOINT FILERS’ SIGNATURES
Napier Park Global Capital GP LLC
By: Manu Rana
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/s/ Manu Rana
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7/30/14
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Signature of Reporting Person
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Date
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