Sec Form 4 Filing - Bergman Artur @ Fastly, Inc. - 2021-07-12

Insider filing report for Changes in Beneficial Ownership
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FORM 4
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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Bergman Artur
2. Issuer Name and Ticker or Trading Symbol
Fastly, Inc. [ FSLY]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Architect, Exec. Chair
(Last) (First) (Middle)
C/O FASTLY, INC., 475 BRANNAN STREET, SUITE 300
3. Date of Earliest Transaction (MM/DD/YY)
07/12/2021
(Street)
SAN FRANCISCO, CA94107
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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
Class A Common Stock 07/12/2021 C 5,716,248 A 6,015,769 D
Class A Common Stock 07/12/2021 C 840,005 A 840,005 I See footnote ( 2 )
Class A Common Stock 07/12/2021 C 209,686 A 209,686 I See footnote ( 3 )
Class A Common Stock 07/12/2021 C 209,686 A 209,686 I See footnote ( 4 )
Class A Common Stock 07/12/2021 C 1,000,000 A 1,000,000 I See footnote ( 5 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Class B Common Stock ( 1 ) 07/12/2021 C 5,716,248 ( 1 ) ( 1 ) Class A Common Stock 5,716,248 $ 0 0 D
Class B Common Stock ( 1 ) 07/12/2021 C 840,005 ( 1 ) ( 1 ) Class A Common Stock 840,005 $ 0 0 I See footnote ( 2 )
Class B Common Stock ( 1 ) 07/12/2021 C 209,686 ( 1 ) ( 1 ) Class A Common Stock 209,686 $ 0 0 I See footnote ( 3 )
Class B Common Stock ( 1 ) 07/12/2021 C 209,686 ( 1 ) ( 1 ) Class A Common Stock 209,686 $ 0 0 I See footnote ( 4 )
Class B Common Stock ( 1 ) 07/12/2021 C 1,000,000 ( 1 ) ( 1 ) Class A Common Stock 1,000,000 $ 0 0 I See footnote ( 5 )
Employee Stock Option (Right to Buy) $ 1.15 07/12/2021 J( 6 ) 918,834 ( 7 ) 06/01/2025 Class B Common Stock 918,834 $ 0 0 D
Employee Stock Option (Right to Buy) $ 1.15 07/12/2021 J( 6 ) 918,834 ( 7 ) 06/01/2025 Class A Common Stock 918,834 $ 0 918,834 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Bergman Artur
C/O FASTLY, INC.
475 BRANNAN STREET, SUITE 300
SAN FRANCISCO, CA94107
X Chief Architect, Exec. Chair
Signatures
/s/ Seth Gottlieb, Attorney-in-Fact 07/12/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )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.
( 2 )The shares are held by The Artur Bergman Remainder Trust One DTD 5/2/2019, of which the reporting person is the investment advisor.
( 3 )The shares are held by The Artur Bergman Remainder Trust Two DTD 5/2/2019, of which the reporting person is the investment advisor.
( 4 )The shares are held by The Artur Bergman Remainder Trust Three DTD 5/2/2019, of which the reporting person is the investment advisor.
( 5 )The shares are held by The Per Artur Bergman Grantor Retained Annuity Trust No. 1, of which the reporting person is trustee.
( 6 )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.
( 7 )Fully vested.

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