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