0000899243-21-048446.txt : 20211215 0000899243-21-048446.hdr.sgml : 20211215 20211215202755 ACCESSION NUMBER: 0000899243-21-048446 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211213 FILED AS OF DATE: 20211215 DATE AS OF CHANGE: 20211215 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Zarmi Sigal CENTRAL INDEX KEY: 0001854208 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41121 FILM NUMBER: 211495613 MAIL ADDRESS: STREET 1: 1501 YAMATO ROAD CITY: BOCA RATON STATE: FL ZIP: 33431 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HashiCorp, Inc. CENTRAL INDEX KEY: 0001720671 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING SERVICES [7371] IRS NUMBER: 320410665 STATE OF INCORPORATION: DE FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 101 2ND STREET, SUITE 700 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 BUSINESS PHONE: 415-301-3227 MAIL ADDRESS: STREET 1: 101 2ND STREET, SUITE 700 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-12-13 0 0001720671 HashiCorp, Inc. HCP 0001854208 Zarmi Sigal C/O HASHICORP, INC. 101 SECOND STREET, SUITE 700 SAN FRANCISCO CA 94105 1 0 0 0 Common Stock 2021-12-13 4 J 0 50000 D 0 D Class B Common Stock 2021-12-13 4 J 0 6250 A Class A Common Stock 6250 6250 D Restricted Stock Units 2021-12-13 4 J 0 43750 A Class B Common Stock 43750 43750 D Pursuant to a reclassification exempt under Rule 16b-7, each share of Common Stock was automatically reclassified into one share of Class B Common Stock immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock. Of the reported shares, 6,250 are represented by shares of Common Stock and the remaining 43,750 are represented by restricted stock units, or RSUs. Each share of Class B Common Stock is convertible into one share of Class A Common Stock at the option of the holder and has no expiration date. Each RSU represents a contingent right to receive one share of Issuer Class B Common Stock. The RSUs vest in 14 equal quarterly installments beginning on December 20, 2021. /s/ Paul Warensky, by power of attorney 2021-12-15