SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Jackman William Richard

(Last) (First) (Middle)
C/O RIOT BLOCKCHAIN, INC.
202 6TH STREET, STE. 401

(Street)
CASTLE ROCK CO 80104

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Riot Blockchain, Inc. [ RIOT ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
General Counsel
3. Date of Earliest Transaction (Month/Day/Year)
12/03/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 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 12/07/2021 M 36,000 A $0.00(1) 36,000(2) D
Common Stock 12/07/2021 D 14,400(3) D $28.64 21,600(2) D
Common Stock 12/07/2021 M 2,657 A $0.00(1) 24,257(2) D
Common Stock 12/07/2021 D 1,063(3) D $28.64 23,194(2) D
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 (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 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: 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
Restricted Stock Units $0.00(2) 12/03/2021 A 6,000 (4) (4) Common Stock 6,000 $0.00(2) 46,630(3) D
Restricted Stock Units $0.00(2) 12/07/2021 M 36,000 (5) (5) Common Stock 36,000 $0.00(2) 10,630(3) D
Restricted Stock Units $0.00(2) 12/07/2021 M 2,657 (6) (6) Common Stock 2,657 $0.00 7,973 D
Explanation of Responses:
1. Pursuant to the Riot Blockchain, Inc. 2019 Equity Incentive Plan, as amended, (the "Plan") each time-based restricted stock unit ("RSU") and performance-based restricted stock unit ("PSUs") represents a contingent right to receive one share of the Issuer's common stock, no par value per share, ("Common Stock") subject to any net settlement permitted under the Plan and approved by the Issuer's Compensation and Human Resources Committee (the "Committee"), following vesting and settlement by the Issuer.
2. Represents the total direct and indirect ownership of the indicated security held by the Reporting Person immediately following the reported transaction.
3. Represents net settlement in connection with the conversion 36,000 vested PSUs and 2,657 vested RSUs into shares of the Issuer's Common Stock, as permitted under the Plan and approved by the Committee.
4. On December 3, 2021, the Committee determined that, as of the end of the third fiscal quarter of 2021, the performance criteria for 6,000 PSUs had been achieved and, therefore, 6,000 PSUs became vested and eligible to be settled by the Issuer in accordance with the Plan. The PSUs were issued to the Reporting Person under the Plan pursuant to the Performance Restricted Stock Unit Award Agreement, dated as of August 12, 2021, between the Issuer and the Reporting Person (the "Award Agreement"), as approved by the Committee.
5. The conversion of 36,000 PSUs reported in Table II represents the settling by the Issuer of the vested portion of the PSUs granted to the Reporting Person pursuant to the Award Agreement, which vested upon the Committee's determination that performance criteria corresponding to 36,000 of the PSUs granted to the Reporting Person had been achieved.
6. The conversion of 2,657 RSUs reported in Table II represents the settling of the vested portion of the 10,630 RSUs awarded to the Reporting Person by the Issuer under the Plan on July 15, 2021, pursuant to an award agreement between the Issuer and the Reporting Person dated as of the grant date, which are eligible to vest in four equal quarterly installments following the grant date.
/s/ Willliam R. Jackman 12/07/2021
** 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.
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