Statement of Changes in Beneficial Ownership (4)
30 Maio 2023 - 06:32PM
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).
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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 * Bergman
Artur |
2. Issuer Name and Ticker or Trading
Symbol Fastly, Inc. [ FSLY ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chief Architect |
(Last)
(First)
(Middle)
C/O FASTLY, INC., 475 BRANNAN STREET, SUITE 300 |
3. Date of Earliest Transaction (MM/DD/YYYY)
5/25/2023
|
(Street)
SAN FRANCISCO, CA 94107 |
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 |
(City)
(State)
(Zip)
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Rule 10b5-1(c) Transaction Indication
☒ Check this box to indicate
that a transaction was made pursuant to a contract, instruction or
written plan that is intended to satisfy the affirmative defense
conditions of Rule 10b5-1(c). See Instruction 10. |
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 |
Class A Common Stock |
5/25/2023 |
|
S(1) |
|
3200 |
D |
$15.17 (2) |
6491443 |
D |
|
Class A Common Stock |
|
|
|
|
|
|
|
840005 |
I |
See Footnote (3) |
Class A Common Stock |
|
|
|
|
|
|
|
209686 |
I |
See Footnote (4) |
Class A Common Stock |
|
|
|
|
|
|
|
209686 |
I |
See Footnote 6. (5) |
Class A Common Stock |
|
|
|
|
|
|
|
1000000 |
I |
See Footnote 6 (6) |
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 |
Explanation of
Responses: |
(1) |
The sale was effected
pursuant to a Rule 10b5-1 trading plan adopted by the reporting
person on June 6, 2022. |
(2) |
The price reported in Column
4 is a weighted average price. These shares were sold in multiple
transactions at prices ranging from $15.00 to $15.44, inclusive.
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) |
The shares are held by The
Artur Bergman Remainder Trust One DTD 5/2/2019, of which the
reporting person is the investment advisor. |
(4) |
The shares are held by The
Artur Bergman Remainder Trust Two DTD 5/2/2019, of which the
reporting person is the investment advisor. |
(5) |
The shares are held by The
Artur Bergman Remainder Trust Three DTD 5/2/2019, of which the
reporting person is the investment advisor. |
(6) |
The shares are held by The
Per Artur Bergman Grantor Retained Annuity Trust No. 2, of which
the reporting person is trustee. |
Reporting
Owners
|
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 Architect |
|
Signatures
|
/s/ Karen Greenstein,
Attorney-in-Fact |
|
5/30/2023 |
**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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