12/11/2024 | Press release | Distributed by Public on 12/11/2024 15:57
FORM 4
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) |
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 (Month/Day/Year) |
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 Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Bergman Artur C/O FASTLY, INC. 475 BRANNAN STREET, SUITE 300 SAN FRANCISCO, CA 94107 |
X | Chief Technology Officer |
/s/ Karen Greenstein, Attorney-in-Fact | 12/11/2024 |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on June 3, 2024. |
(2) | The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $11.02 to $11.57. The reporting person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the SEC, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in footnote (2) to this Form 4. |
(3) | Balance reflects 2,500,558 shares of Class A common stock transferred to The Per Artur Bergman Revocable Trust, of which the reporting person is settlor, sole trustee, and sole beneficiary. |
(4) | The shares are held by The Per Artur Bergman Revocable Trust, of which the reporting person is settlor, sole trustee, and sole beneficiary. |
(5) | The shares are held by The Artur Bergman Remainder Trust One DTD 5/2/2019, of which the reporting person is the investment advisor. |
(6) | The shares are held by The Artur Bergman Remainder Trust Three DTD 5/2/2019, of which the reporting person is the investment advisor. |
(7) | The shares are held by The Per Artur Bergman Grantor Retained Annuity Trust No. 2, of which the reporting person is trustee. |
(8) | The shares are held by The Per Artur Bergman Grantor Retained Annuity Trust No. 3, of which the reporting person is trustee. |
(9) | The shares are held by The Per Artur Bergman Grantor Retained Annuity Trust No. 4, of which the reporting person is trustee. Includes 561,170 shares of Class A common stock received as annuity payments from The Per Artur Bergman Grantor Retained Annuity Trust No. 2 and 231,828 shares of Class A common stock received as annuity payments from The Per Artur Bergman Grantor Retained Annuity Trust No. 3. |