0001209191-21-046377.txt : 20210712
0001209191-21-046377.hdr.sgml : 20210712
20210712211247
ACCESSION NUMBER: 0001209191-21-046377
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210712
FILED AS OF DATE: 20210712
DATE AS OF CHANGE: 20210712
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bergman Artur
CENTRAL INDEX KEY: 0001769490
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38897
FILM NUMBER: 211086648
MAIL ADDRESS:
STREET 1: C/O FASTLY, INC.
STREET 2: 475 BRANNAN STREET, SUITE 300
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Fastly, Inc.
CENTRAL INDEX KEY: 0001517413
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 275411834
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 475 BRANNAN
STREET 2: SUITE 300
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
BUSINESS PHONE: 415-525-3481
MAIL ADDRESS:
STREET 1: 475 BRANNAN
STREET 2: SUITE 300
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
FORMER COMPANY:
FORMER CONFORMED NAME: Skycache, Inc.(DE)
DATE OF NAME CHANGE: 20110405
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-07-12
0
0001517413
Fastly, Inc.
FSLY
0001769490
Bergman Artur
C/O FASTLY, INC.
475 BRANNAN STREET, SUITE 300
SAN FRANCISCO
CA
94107
1
1
0
0
Chief Architect, Exec. Chair
Class A Common Stock
2021-07-12
4
C
0
5716248
A
6015769
D
Class A Common Stock
2021-07-12
4
C
0
840005
A
840005
I
See footnote
Class A Common Stock
2021-07-12
4
C
0
209686
A
209686
I
See footnote
Class A Common Stock
2021-07-12
4
C
0
209686
A
209686
I
See footnote
Class A Common Stock
2021-07-12
4
C
0
1000000
A
1000000
I
See footnote
Class B Common Stock
2021-07-12
4
C
0
5716248
0.00
D
Class A Common Stock
5716248
0
D
Class B Common Stock
2021-07-12
4
C
0
840005
0.00
D
Class A Common Stock
840005
0
I
See footnote
Class B Common Stock
2021-07-12
4
C
0
209686
0.00
D
Class A Common Stock
209686
0
I
See footnote
Class B Common Stock
2021-07-12
4
C
0
209686
0.00
D
Class A Common Stock
209686
0
I
See footnote
Class B Common Stock
2021-07-12
4
C
0
1000000
0.00
D
Class A Common Stock
1000000
0
I
See footnote
Employee Stock Option (Right to Buy)
1.15
2021-07-12
4
J
0
918834
0.00
D
2025-06-01
Class B Common Stock
918834
0
D
Employee Stock Option (Right to Buy)
1.15
2021-07-12
4
J
0
918834
0.00
A
2025-06-01
Class A Common Stock
918834
918834
D
On October 12, 2020, the Issuer's outstanding shares of Class B Common Stock represented less than 10% of the aggregate number of shares of the then outstanding Class A Common Stock and Class B Common Stock. As a result, each share of the Issuer's Class B Common Stock automatically converted into one share of Class A Common Stock pursuant to the Issuer's amended and restated certificate of incorporation, as amended, on July 12, 2021.
The shares are held by The Artur Bergman Remainder Trust One DTD 5/2/2019, of which the reporting person is the investment advisor.
The shares are held by The Artur Bergman Remainder Trust Two DTD 5/2/2019, of which the reporting person is the investment advisor.
The shares are held by The Artur Bergman Remainder Trust Three DTD 5/2/2019, of which the reporting person is the investment advisor.
The shares are held by The Per Artur Bergman Grantor Retained Annuity Trust No. 1, of which the reporting person is trustee.
In connection with the automatic conversion described in footnote (1), outstanding Class B Common Stock options that were issued under the Issuer's 2011 Equity Incentive Plan remain unchanged, except that the underlying shares are now Class A Common Stock.
Fully vested.
/s/ Seth Gottlieb, Attorney-in-Fact
2021-07-12