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*
C/O CONFLUENT, INC. |
899 W. EVELYN AVENUE |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 08/16/2023
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3. Issuer Name and Ticker or Trading Symbol
Confluent, Inc.
[ CFLT ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
Chief Financial Officer |
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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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Class A Common Stock |
174,890
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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) |
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10/28/2030 |
Class B Common Stock |
147,813 |
7.34 |
D |
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Explanation of Responses: |
Remarks: |
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/s/ Melanie Vinson, Attorney-in-fact |
08/24/2023 |
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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
Know all by these presents, that the undersigned hereby constitutes and appoints
Melanie Vinson and Weilyn
Wood of Confluent, Inc. and Jon Avina, Milson Yu and Eric Steiner of Cooley LLP,
or any of them signing singly, with
full power of substitution, the undersigned's true and lawful attorney-in-fact
to:
(1) prepare, execute in the undersigned's name and on the undersigned's behalf,
and submit to the U.S.
Securities and Exchange Commission (the "SEC") a Form ID Application to obtain
EDGAR Access
Codes and any other forms necessary to generate EDGAR codes on the undersigned's
behalf enabling
the undersigned to make electronic filings with the SEC of reports required by
Section 16(a) of the
Securities Exchange Act of 1934 or any rule or regulation of the SEC;
(2) execute for and on behalf of the undersigned, in the undersigned's capacity
as a director, officer and/or
a 10% stockholder of Confluent, Inc. (the "Company"), Forms 3, 4, and 5
(including any amendments
thereto) in accordance with Section 16(a) of the Securities Exchange Act of 1934
and the rules
thereunder;
(3) 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, complete and execute
any amendment or
amendments thereto, and timely file such form with the SEC and any stock
exchange or similar
authority; and
(4) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion
of such attorney-in-fact, may be of benefit to, in the best interest of, or
legally required by, the
undersigned, it being understood that the documents executed by such
attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and
conditions as such attorney-in-fact may approve in such attorney-in-fact's
discretion.
The undersigned hereby grants to such attorney-in-fact full power and authority
to do and perform any and
every act and thing whatsoever requisite, 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 power of attorney and
the rights and powers herein granted. The undersigned acknowledges that the
foregoing attorneys-in-fact, in serving in
such capacity at the request of the undersigned, are not assuming, nor is the
Company assuming, any of the undersigned's
responsibilities to comply with Section 16 of the Securities Exchange Act of
1934.
This Power of Attorney shall remain in full force and effect until the earliest
to occur of (i) the undersigned is
no longer required to file Forms 3, 4, and 5 with respect to the undersigned's
holdings of and transactions in securities
issued by the Company, (ii) revocation by the undersigned in a signed writing
delivered to the foregoing attorneys-in-fact,
or (iii) as to any attorney-in-fact individually, until such attorney-in-fact is
no longer employed by the Company or
employed by or a partner at Cooley LLP, as applicable.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of July 29, 2023.
/s/ Rohan Sivaram