Statement of Changes in Beneficial Ownership (4)
19 Oktober 2022 - 11:59PM
Edgar (US Regulatory)
FORM 4
[X] Check this box if no longer subject to
Section 16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
|
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 * PINNEY ALESIA LEE |
2. Issuer Name and Ticker or Trading
Symbol AVALARA, INC. [ AVLR ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
See Remarks |
(Last)
(First)
(Middle)
255 SOUTH KING ST., SUITE 1800 |
3. Date of Earliest Transaction (MM/DD/YYYY)
10/19/2022
|
(Street)
SEATTLE, WA 98104
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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. 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 |
Common Stock |
10/19/2022 |
|
D(1) |
|
49840 (1) |
D |
$93.50 (1) |
0 |
D |
|
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 |
Stock Option (right to buy) |
$16.60 |
10/19/2022 |
|
D (2) |
|
|
3727 |
(3) |
1/23/2028 |
Common Stock |
3727 |
$76.90 (2) |
0 |
D |
|
Stock Option (right to buy) |
$39.76 |
10/19/2022 |
|
D (2) |
|
|
7408 |
(4) |
1/28/2029 |
Common Stock |
7408 |
$53.74 (2) |
0 |
D |
|
Stock Option (right to buy) |
$67.27 |
10/19/2022 |
|
D (2) |
|
|
7272 |
(5) |
3/12/2030 |
Common Stock |
7272 |
$26.23 (2) |
0 |
D |
|
Performance Share Units |
(6) |
10/19/2022 |
|
A (7) |
|
12694 |
|
(8) |
1/5/2024 |
Common Stock |
12694 |
$93.50 (8) |
12694 |
D |
|
Performance Share Units |
(6) |
10/19/2022 |
|
D (8) |
|
|
12694 |
(8) |
1/5/2024 |
Common Stock |
12694 |
$93.50 (8) |
0 |
D |
|
Performance Share Units |
(6) |
10/19/2022 |
|
A (9) |
|
17009 |
|
(8) |
1/5/2025 |
Common Stock |
17009 |
$93.50 (8) |
17009 |
D |
|
Performance Share Units |
(6) |
10/19/2022 |
|
D (8) |
|
|
17009 |
(8) |
1/5/2025 |
Common Stock |
17009 |
$93.50 (8) |
0 |
D |
|
Explanation of
Responses: |
(1) |
Disposed of pursuant to the
Agreement and Plan of Merger (the "Merger Agreement"), dated as of
August 8, 2022, by and among the Issuer, Lava Intermediate, Inc.
and Lava Merger Sub, Inc., pursuant to which the outstanding shares
of the Issuer's Common Stock (other than certain excluded shares)
were converted into the right to receive, without interest, the
cash merger consideration of $93.50 per share. Amount includes
31,049 restricted stock units ("RSUs") held by the Reporting Person
whose acquisition was previously reported in Table I that were
cancelled and converted into the contingent right to receive,
without interest, $93.50 per share subject to such RSUs, less
applicable withholding taxes, with payments subject to the same
time-vesting terms and conditions applicable to the corresponding
RSUs immediately prior to the effective time of the
merger. |
(2) |
Pursuant to the Merger
Agreement, immediately prior to the effective time of the merger,
the option was cancelled and converted into the right to receive,
without interest, the cash merger consideration of $93.50 for each
share subject to the option (whether vested or unvested), less the
per share exercise price and applicable withholding
taxes |
(3) |
The option originally
provided that 25% of the total shares subject to the option vested
and became exercisable on January 1, 2019, and 1/48th of the total
shares subject to the option vested and became exercisable monthly
thereafter such that the option was fully vested and exercisable on
January 1, 2022. The option was converted into the right to receive
the merger consideration with respect to the entire option as set
forth in footnote 2. |
(4) |
The option, which originally
provided that 25% of the total shares subject to the option vested
and became exercisable on January 1, 2020, and 1/48th of the total
shares subject to the option vested and became exercisable monthly
thereafter, was converted into the right to receive the merger
consideration with respect to the entire option as set forth in
footnote 2. |
(5) |
The option, which originally
provided that 25% of the total shares subject to the option vested
and became exercisable on March 5, 2021, and 1/48th of the total
shares subject to the option vested and became exercisable monthly
thereafter, was converted into the right to receive the merger
consideration with respect to the entire option as set forth in
footnote 2. |
(6) |
Each performance share unit
("PSU") represents the economic equivalent of one share of Issuer
Common Stock. |
(7) |
Represents PSUs with an
initial three-year performance period commencing on January 1,
2021, that were originally scheduled to vest annually over the
remaining performance period based on the achievement of certain
performance conditions and that were not required to be reported
prior to satisfaction of such performance-based vesting conditions.
The number reported represents the number of PSUs eligible for cash
consideration in the merger, determined in accordance with the
Merger Agreement. |
(8) |
Pursuant to the Merger
Agreement, immediately prior to the effective time of the merger,
the PSUs were cancelled and converted into the contingent right to
receive, without interest, the cash merger consideration of $93.50
per share subject to the PSUs, less applicable withholding taxes,
with payments to be made in accordance with the vesting terms and
conditions set forth in the award agreement for the PSUs in the
event of a "change in control," which award agreement generally
provides for quarterly time-vesting over the remaining performance
period applicable to the PSUs. |
(9) |
Represents PSUs with an
initial three-year performance period commencing on January 1,
2022, that were originally scheduled to vest annually over the
performance period based on the achievement of certain performance
conditions and that were not required to be reported prior to the
satisfaction of the performance-based vesting conditions. The
number reported represents the number of PSUs eligible for cash
consideration in connection with the merger, determined in
accordance with the Merger Agreement. |
Remarks:
Executive Vice President, Chief Legal Officer, and Secretary |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
PINNEY ALESIA LEE
255 SOUTH KING ST.
SUITE 1800
SEATTLE, WA 98104 |
|
|
See Remarks |
|
Signatures
|
/s/ Miles Treakle,
Attorney-in-Fact |
|
10/19/2022 |
**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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