Sec Form 3 Filing - SEQUOIA CAPITAL ISRAEL IV HOLDINGS, L.P. @ Innovid Corp. - 2021-11-30

Insider filing report for Changes in Beneficial Ownership
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FORM 3
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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
SEQUOIA CAPITAL ISRAEL IV HOLDINGS, L.P.
2. Issuer Name and Ticker or Trading Symbol
Innovid Corp. [ CTV]
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)
50 ELI LANDAU BLVD.
3. Date of Earliest Transaction (MM/DD/YY)
11/30/2021
(Street)
HERZELIA, L34685150
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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 17,697,224 I See Footnote( 1 )( 2 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
SEQUOIA CAPITAL ISRAEL IV HOLDINGS, L.P.
50 ELI LANDAU BLVD .
HERZELIA, L34685150
X
SC ISRAEL IV GENPAR, LTD.
50 ELI LANDAU BLVD.
HERZELIA, L34685150
X
SC ISRAEL IV MANAGEMENT, L.P.
50 ELI LANDAU BLVD.
HERZELIA, L34685150
X
SEQUOIA CAPITAL ISRAEL IV, L.P.
50 ELI LANDAU BLVD.
HERZELIA, L34685150
X
Levy Shmuel
50 ELI LANDAU BLVD
HERZELIA, L34685150
X
SADGER HAIM
50 ELI LANDAU BLVD
HERZELIA, L34685150
X
Signatures
/s/ By Shmuel Levy, a Director of SC ISRAEL IV GENPAR, LTD 12/10/2021
Signature of Reporting Person Date
/s/ By Shmuel Levy, a Director of SC ISRAEL IV GENPAR, LTD, the general partner of SC ISRAEL IV MANAGEMENT, L.P. 12/10/2021
Signature of Reporting Person Date
/s/ By Shmuel Levy, a Director of SC ISRAEL IV GENPAR, LTD, the general partner of SC ISRAEL IV MANAGEMENT, L.P., the general partner of SEQUOIA CAPITAL ISRAEL IV L.P. 12/10/2021
Signature of Reporting Person Date
/s/ By Shmuel Levy, a Director of SC ISRAEL IV GENPAR, LTD, the general partner of SC ISRAEL IV MANAGEMENT, L.P., the general partner of SEQUOIA CAPITAL ISRAEL IV L.P., which owns 100% of SEQUOIA CAPITAL ISRAEL IV HOLDINGS, L.P 12/10/2021
Signature of Reporting Person Date
/s/ Shmuel Levy 12/10/2021
Signature of Reporting Person Date
/s/ Haim Sadger 12/10/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )SC ISRAEL IV GENPAR, LTD is the general partner of SC ISRAEL IV MANAGEMENT, L.P., which is the general partner of SEQUOIA CAPITAL ISRAEL IV L.P., which owns 100% of SEQUOIA CAPITAL ISRAEL IV HOLDINGS, L.P. As such, SC ISRAEL IV GENPAR, LTD shares voting and dispositive power with respect to the shares held by SEQUOIA CAPITAL ISRAEL IV HOLDINGS, L.P. The directors and stockholders of SC ISRAEL IV GENPAR, LTD. who exercise voting and investment discretion with respect to the shares held by SEQUOIA CAPITAL ISRAEL IV HOLDINGS, L.P. are Shmuel Levy and Haim Sadger. As a result, and by virtue of the relationship described in this footnote, each such person may be deemed to share voting and dispositive power with respect to the shares held by the Sequoia Capital Israel IV Holdings, L.P.
( 2 )Each of SC ISRAEL IV GENPAR, LTD, SC ISRAEL IV MANAGEMENT, L.P., SEQUOIA CAPITAL ISRAEL IV L.P., Mr. Levy and Mr. Sadger disclaims beneficial ownership of the shares held by SEQUOIA CAPITAL ISRAEL IV HOLDINGS, L.P. except to the extent of its or his pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.

Remarks:
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.

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.
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