Statement of Changes in Beneficial Ownership (4)
21 Mai 2019 - 10:16PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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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
*
RIZAI MATTHEW M
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2. Issuer Name
and
Ticker or Trading Symbol
WORKIVA INC
[
WK
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
2900 UNIVERSITY BOULEVARD
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3. Date of Earliest Transaction
(MM/DD/YYYY)
5/17/2019
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(Street)
AMES, IA 50010
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Class A Common Stock
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5/17/2019
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S
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66585
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D
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$53
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260011
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D
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Class A Common Stock
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5/17/2019
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S
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533415
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D
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$53
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41585
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I
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By Trust
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option to Purchase Class A Common Stock
(1)
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$12.4
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2/1/2018
(2)
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1/31/2027
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Class A Common Stock
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200204.0
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200204
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D
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Employee Stock Option to Purchase Class A Common Stock
(1)
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$14.74
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2/1/2017
(2)
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1/31/2026
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Class A Common Stock
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168421.0
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168421
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D
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Employee Stock Option to Purchase Class A Common Stock
(3)
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$15.83
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8/12/2015
(4)
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8/11/2024
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Class A Common Stock
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178200.0
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178200
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D
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Class B Common Stock
(5)
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(5)
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(5)
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(5)
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Class A Common Stock
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1292058.0
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1292058
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I
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By trust
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Class B Common Stock
(5)
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(5)
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(5)
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(5)
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Class A Common Stock
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32783.0
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32783
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D
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Class B Common Stock
(5)
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(5)
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(5)
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(5)
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Class A Common Stock
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201630.0
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201630
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I
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By family trusts
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Class B Common Stock
(5)
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(5)
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(5)
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(5)
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Class A Common Stock
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885109.0
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885109
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I
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By marital trust
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Class B Common Stock
(5)
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(5)
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(5)
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(5)
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Class A Common Stock
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489113.0
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489113
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I
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By charitable remainder trust
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Explanation of Responses:
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(1)
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Grant of stock option pursuant to the 2014 Equity Incentive Plan.
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(2)
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Vests in three equal annual installments commencing on the first anniversary of the grant date.
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(3)
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Granted pursuant to 2009 Unit Incentive Plan.
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(4)
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Vests as to 25% of the shares on the first anniversary of the grant date and as to 6.25% of the shares at the end of each three-month period thereafter.
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(5)
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Each share of Class B Common Stock is convertible, at any time at the election of the holder, into one share of Class A Common Stock. In addition, each share of Class B Common Stock will convert automatically into one share of Class A Common Stock upon (i) the date specified by the holders of at least 66 2/3% of the outstanding shares of Class B Common Stock, (ii) any transfer, except for certain "qualified transfers" (as defined in the Issuer's Certificate of Incorporation) or (iii) upon the death of a natural person holding shares of Class B Common Stock (subject to certain exceptions as defined in the Issuer's Certificate of Incorporation).
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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RIZAI MATTHEW M
2900 UNIVERSITY BOULEVARD
AMES, IA 50010
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X
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Signatures
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/s/ Troy M. Calkins as attorney-in-fact
for Matthew M. Rizai
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5/21/2019
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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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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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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