Statement of Changes in Beneficial Ownership (4)
04 February 2021 - 9:23AM
Edgar (US Regulatory)
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
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3235-0287
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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
*
VANDERPLOEG MARTIN J. |
2. Issuer Name and Ticker or Trading Symbol
WORKIVA INC
[
WK
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
President & CEO |
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(Last)
(First)
(Middle)
2900 UNIVERSITY BOULEVARD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
2/1/2021 |
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(Street)
AMES, IA 50010
(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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| Class A Common Stock | 2/1/2021 | | C | | 50000 | A | $0 | 395952 | D | |
| Class A Common Stock | 2/1/2021 | | A(1) | | 49383 (2) | A | $101.25 | 445335 | D | |
| Class A Common Stock | 2/1/2021 | | F(3) | | 7729 | D | $101.25 | 437606 | D | |
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) | 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 |
| Class B Common Stock (4) | (4) | 2/1/2021 | | C | | | 50000 | (4) | (4) | Class A Common Stock | 50000.0 | $0 | 2104023 | I | By living trust |
| Class B Common Stock (4) | (4) | | | | | | | (4) | (4) | Class A Common Stock | 889020.0 | | 889020 | I | By charitable remainder trust |
| Employee Stock Option to Purchase Class A Common Stock (5) | $12.4 | | | | | | | 2/1/2018 (2) | 1/31/2027 | Class A Common Stock | 200204.0 | | 200204 | D | |
| Employee Stock Option to Purchase Class A Common Stock (5) | $14.74 | | | | | | | 2/1/2017 (2) | 1/31/2026 | Class A Common Stock | 168421.0 | | 168421 | D | |
| Employee Stock Option to Purchase Class A Common Stock (6) | $15.83 | | | | | | | 8/12/2015 (7) | 8/11/2024 | Class A Common Stock | 178200.0 | | 178200 | D | |
| Explanation of Responses: |
| (1) | Grant of restricted stock units pursuant to the 2014 Equity Incentive Plan. |
| (2) | Vests in three equal annual installments commencing on the first anniversary of the grant date. |
| (3) | Shares delivered to the issuer for payment of withholding taxes due upon the vesting of restricted stock units previously granted. |
| (4) | Each share of Class B Common Stock is convertible, at any time at the election of the holder, into one share of Class A Common Stock. In addition, each share of Class B Common Stock will convert automatically into one share of Class A Common Stock upon (i) the date specified by the holders of at least 66 2/3% of the outstanding shares of Class B Common Stock, (ii) any transfer, except for certain "qualified transfers" (as defined in the Issuer's Certificate of Incorporation) or (iii) upon the death of a natural person holding shares of Class B Common Stock (subject to certain exceptions as defined in the Issuer's Certificate of Incorporation). |
| (5) | Grant of stock option pursuant to the 2014 Equity Incentive Plan. |
| (6) | Granted pursuant to 2009 Unit Incentive Plan. |
| (7) | Vests as to 25% of the shares on the first anniversary of the grant date and as to 6.25% of the shares at the end of each three-month period thereafter. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
VANDERPLOEG MARTIN J.
2900 UNIVERSITY BOULEVARD
AMES, IA 50010 | X | X | President & CEO |
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Signatures
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| /s/ Brandon E. Ziegler as attorney-in-fact for Martin J. Vanderploeg | | 2/3/2021 |
| **Signature of Reporting Person | Date |
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