Statement of Changes in Beneficial Ownership (4)
23 August 2016 - 6:35AM
Edgar (US Regulatory)
FORM 4
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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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1. Name and Address of Reporting Person
*
Tomlinson Steffan
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2. Issuer Name
and
Ticker or Trading Symbol
QLIK TECHNOLOGIES INC
[
QLIK
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
C/O PALO ALTO NETWORKS INC.,, 3300 OLCOTT STREET
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3. Date of Earliest Transaction
(MM/DD/YYYY)
8/22/2016
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(Street)
SANTA CLARA, CA 95054
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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8/22/2016
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D
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7700
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D
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(1)
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0
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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 Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option (Right to Buy)
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$27.21
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8/22/2016
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D
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48263
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(2)
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3/7/2023
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Common Stock
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48263
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$3.29
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0
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D
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Restricted Stock Unit
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(3)
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8/22/2016
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D
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6500
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(4)
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(5)
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Common Stock
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6500
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$30.50
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0
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D
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Explanation of Responses:
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(
1)
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Disposed of pursuant to the Agreement and Plan of Merger between Issuer, Project Alpha Holding, LLC and Project Alpha Merger Corp. (the "Merger Agreement"), whereby, immediately prior to the effective time of the merger contemplated therein (the "Effective Time"), all issued and outstanding shares of Issuer common stock were converted into the right to receive $30.50 per share in cash and, when so converted, automatically cancelled.
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(
2)
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This option, which provided for vesting with respect to one-twelfth (1/12) of the shares of stock which are subject to this option in equal increments quarterly over three (3) years beginning April 28, 2013, provided Reporting Person remained continuously employed by the Issuer through the last day of each quarterly period, was cancelled pursuant to the Merger Agreement and, as soon as possible following the Effective Time, the Reporting Person was entitled to receive a cash payment equal to the product of (1) the difference between the exercise price and $30.50 and (2) the number of unexercised options.
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(
3)
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Each restricted stock unit ("RSU") represented a contingent right to receive one share of the Issuer's common stock.
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(
4)
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The RSU, which provided for vesting and settlement on May 12, 2017 was cancelled pursuant to the Merger Agreement and the Reporting Person became entitled to receive an initial cash payment equal to the product of $30.50 and the sum of the number of vested but unsettled shares of common stock and 1/3 of the unvested shares of common stock subject to this RSU. The Reporting Person shall be entitled to receive a payment for the remaining 2/3 of the unvested shares of common stock subject to this RSU in equal portions promptly following the 12 and 18 month anniversaries of the Effective Time or upon the earlier date as the RSU was scheduled to vest according to the original vesting conditions, provided the Reporting Person remains continuously employed by the Issuer through such date and provided further that if the Reporting Person is terminated without cause, the vesting conditions will be deemed satisfied on the Reporting Person's last day of employment.
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(
5)
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Not applicable.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Tomlinson Steffan
C/O PALO ALTO NETWORKS INC.,
3300 OLCOTT STREET
SANTA CLARA, CA 95054
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X
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Signatures
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/s/ Deborah C. Lofton, Attorney-in-Fact for Steffan Tomlinson
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8/22/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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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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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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