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 IAC/INTERACTIVECORP |
555 W. 18TH STREET |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/24/2011
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3. Issuer Name and Ticker or Trading Symbol
ACTIVE NETWORK INC
[ ACTV ]
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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 |
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 A-4 Preferred Stock |
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Common Stock |
1,167,315 |
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I |
IAC/InterActiveCorp
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Series B-3 Preferred Stock |
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Common Stock |
4,863,813 |
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I |
IAC/InterActiveCorp
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Series B-5 Preferred Stock |
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Common Stock |
952,381 |
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I |
IAC/InterActiveCorp
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Series B-6 Preferred Stock |
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Common Stock |
5,625,243 |
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I |
IAC/InterActiveCorp
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Series D Preferred Stock |
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Common Stock |
245,481 |
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I |
IAC/InterActiveCorp
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Series F Preferred Stock |
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Common Stock |
3,461,018 |
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I |
IAC/InterActiveCorp
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1. Name and Address of Reporting Person*
C/O IAC/INTERACTIVECORP |
555 W. 18TH STREET |
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
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See Signatures on Exhibit |
05/24/2011 |
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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. |
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EXHIBIT 99.1
FORM 3 JOINT FILER INFORMATION
Name of Joint Filers: Elicia Acquisition Corp.
IAC/InterActiveCorp
Address of Joint Filers: c/o IAC/InterActive Corp
555 W. 18th Street
New York, NY 10011
Designated Filer: Elicia Acquisition Corp.
Issuer and Ticker Symbol: The Active Network, Inc. (ACTV)
Date of Event: May 24, 2011
Signatures of Joint Filers
Elicia Acquisition Corp.
By: /s/ Tanya M. Stanich
Name: Tanya M. Stanich
Title: Vice President & Asst.
Secretary
IAC/InterActiveCorp
By: /s/ Tanya M. Stanich
Name: Tanya M.Stanich
Title: Asst. Secretary