Statement of Changes in Beneficial Ownership (4)

Date : 09/13/2017 @ 1:53PM
Source : Edgar (US Regulatory)
Stock : Determine, Inc. (MM) (DTRM)
Quote : 2.05  0.05 (2.50%) @ 4:00PM
Determine, Inc. share price Chart

Statement of Changes in Beneficial Ownership (4)

FORM 4
[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).         
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
                                                                                  
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response...
0.5
                      
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

MILLER LLOYD I III
2. Issuer Name and Ticker or Trading Symbol

DETERMINE, INC. [ DTRM ]
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                      __ X __ 10% Owner
_____ Officer (give title below)      _____ Other (specify below)
(Last)          (First)          (Middle)

3300 SOUTH DIXIE HIGHWAY, SUITE 1-365
3. Date of Earliest Transaction (MM/DD/YYYY)

9/11/2017
(Street)

WEST PALM BEACH, FL 33405
(City)        (State)        (Zip)
4. If Amendment, Date Original Filed (MM/DD/YYYY)

 
6. Individual or Joint/Group Filing (Check Applicable Line)

_ X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Trans. Date 2A. Deemed Execution Date, if any 3. Trans. Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock                  839575   (1) I   By Trust A-4 - Lloyd I. Miller  
Common Stock                  250820   D    
Common Stock                  1353315   (1) I   By Milfam II L.P.  
Common Stock                  334590   (1) I   By Trust C - Lloyd I. Miller  
Common Stock                  2100   (1) I   By Trust D - Lloyd I. Miller  
Common Stock                  211351   (1) I   By Milfam I L.P.  

Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Trans. Date 3A. Deemed Execution Date, if any 4. Trans. Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
6. Date Exercisable and Expiration Date 7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Junior Secured Convertible Promissory Note   $3.00                    12/27/2016   12/27/2021   Common Stock   333333     333333   (1) I   By Milfam II L.P.  
PIK Interest on Junior Secured Convertible Promissory Note   $3.00                    12/27/2016   12/27/2021   Common Stock   20652   (2)   20652   (1) (3) I   By Milfam II L.P.  
Junior Secured Convertible Promissory Note   $3.00                    12/16/2015   12/16/2020   Common Stock   200000     200000   D    
PIK Interest on Junior Secured Convertible Promissory Note   $3.00                    12/16/2015   12/16/2020   Common Stock   15377   (2)   15377   (3) D    
Junior Secured Convertible Promissory Note   $3.00                    12/16/2015   12/16/2020   Common Stock   200000     200000   (1) I   By Milfam II L.P.  
PIK Interest on Junior Secured Convertible Promissory Note   $3.00                    12/16/2015   12/16/2020   Common Stock   15377   (2)   15377   (1) (3) I   By Milfam II L.P.  
Junior Secured Convertible Promissory Note   $3.00                    12/16/2015   12/16/2020   Common Stock   200000     200000   (1) I   By Trust A-4 - Lloyd I. Miller  
PIK Interest on Junior Secured Convertible Promissory Note   $3.00                    12/16/2015   12/16/2020   Common Stock   15377   (2)   15377   (1) (3) I   By Trust A-4 - Lloyd I. Miller  
Junior Secured Convertible Promissory Notes   $5.70                      (4) 12/16/2020   Common Stock   132015   (5)   132015   (1) (3) (5) I   By Milfam II L.P.  
PIK Interest on Junior Secured Convertible Promissory Note   $5.70   9/11/2017     J      20437.42         (4) 12/16/2020   Common Stock   3585   (5)   (2) 3585   (1) (5) I   By Milfam II L.P.  
Junior Secured Convertible Promissory Notes   $5.70                      (4) 12/16/2020   Common Stock   132015   (5)   132015   (3) (5) D    
PIK Interest on Junior Secured Convertible Promissory Note   $5.70   9/11/2017     J      20437.37         (4) 12/16/2020   Common Stock   3585   (5)   (2) 3585   (5) D    
Junior Secured Convertible Promissory Notes   $5.70                      (4) 12/16/2020   Common Stock   132015   (5)   132015   (1) (3) (5) I   By Trust A-4 - Lloyd I. Miller  
PIK Interest on Junior Secured Convertible Promissory Note   $5.70   9/11/2017     J      20437.37         (4) 12/16/2020   Common Stock   3585   (5)   (2) 3585   (1) (5) I   By Trust A-4 - Lloyd I. Miller  
Additional Extension Payment Shares     (6)                    (6)   (6) Common Stock   10417     10417   D    
Additional Extension Payment Shares     (6)                    (6)   (6) Common Stock   10417     10417   (1) I   By Milfam II L.P.  
Warrant   $6.00                      (7)   (8) Common Stock   79787     79787   (1) I   By Milfam I L.P.  
Warrant   $6.00                      (7)   (8) Common Stock   79787     79787   (1) I   By Milfam II L.P.  
Warrant   $6.00                      (7)   (8) Common Stock   79787     79787   (1) I   By Trust C - Lloyd I. Miller  
Warrant   $7.00                    8/27/2014   8/27/2019   Common Stock   49401     49401   (1) I   By Trust A-4 - Lloyd I. Miller  
Warrant   $7.00                    8/27/2014   8/27/2019   Common Stock   13722     13722   (1) I   By Trust C - Lloyd I. Miller  
Warrant   $7.00                    8/27/2014   8/27/2019   Common Stock   74102     74102   (1) I   By Milfam II L.P.  
Warrant   $7.00                    7/24/2014   7/24/2019   Common Stock   57558     57558   (1) I   By Trust A-4 - Lloyd I. Miller  
Warrant   $7.00                    7/24/2014   7/24/2019   Common Stock   15988     15988   (1) I   By Trust C - Lloyd I. Miller  
Warrant   $7.00                    7/24/2014   7/24/2019   Common Stock   86338     86338   (1) I   By Milfam II L.P.  
Series A Warrant   $7.75                    12/1/2013   5/31/2018   Common Stock   40894     40894   (1) I   By Trust A-4 - Lloyd I. Miller  
Series A Warrant   $7.75                    12/1/2013   5/31/2018   Common Stock   11359     11359   (1) I   By Trust C - Lloyd I. Miller  
Series A Warrant   $7.75                    12/1/2013   5/31/2018   Common Stock   61342     61342   (1) I   By Milfam II L.P.  

Explanation of Responses:
(1)  The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. This filing shall not be deemed an admission that the reporting person is, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any equity securities covered by this filing.
(2)  At the election of the Issuer, the quarterly interest payment has been paid as paid-in-kind interest compounded to the original principal amount of the Note.
(3)  Includes all previously reported PIK Interest on Junior Secured Convertible Promissory Note
(4)  As previously reported, the issuer entered into a binding term sheet with the reporting person pursuant to which the issuer agreed to issue and the reporting person agreed to purchase, junior secured convertible promissory notes in the aggregate principal amount of $3 million subject to negotiation and execution of definitive documentation. On March 11, 2015, the notes were executed and on May 5, 2015, the shareholders approved the conversion of the notes at the stockholders meeting.
(5)  Subject to adjustment for fractional shares.
(6)  Pursuant to the Guaranty Fee Agreement, in the event that the maturity date of April 30, 2019 is extended, which extended termination date shall be no later than July 30, 2020, the Issuer agrees to pay Lloyd I. Miller, III and Milfam II L.P. the shares of common stock referenced herein.
(7)  Such Warrant will be exercisable six months following the date of issuance, February 6, 2015.
(8)  Such Warrant will expire on the fifth anniversary of the exercisability date.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
MILLER LLOYD I III
3300 SOUTH DIXIE HIGHWAY
SUITE 1-365
WEST PALM BEACH, FL 33405

X


Signatures
/s/ Paul N. Silverstein Attorney-in-fact 9/13/2017
** 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 4(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 control number.

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