SEC Form 4 · accession 0001209191-17-002287
BLACKHAWK NETWORK HOLDINGS, INC · HAWK
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jerry N Ulrich
Officer — CFO & Chief Admin Officer
Period of report
Jan 3, 2017
Accepted (ET)
Jan 5, 2017 · 5:56 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001411488
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jan 3, 2017 | M | 18,810 | $0.00 | A | 50,165 | D | |
| Common StockF2 | Jan 3, 2017 | F | 7,183 | $38.00 | D | 42,982 | D | |
| Common StockF3 | holding | — | — | — | 6,000 | I | See Footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Performance Shares (PSU)F4,F5 | — | Jan 3, 2017 | M | 18,810 | D | Jan 3, 2017 | — | Common Stock | 18,810 | 0 | D |
Explanation of responses
- F1Includes 570 shares acquired on April 29, 2016 under the Blackhawk Network Holdings, Inc. 2013 Employee Stock Purchase Plan.
- F2Shares tendered in payment of the tax withholding obligation for the performance shares issued on January 3, 2017 under the 2014 Performance Share Award Agreement.
- F3The shares are held by The Ulrich Family Trust Dated November 1, 1996 as Amended and Restated in 2011.
- F4Represents the performance shares earned under the 2014 performance share award as of February 23, 2015, at which date the Compensation Committee certified the extent to which the 2014 performance criteria were met. Each earned performance share represents the contingent right to receive one share of Common Stock.
- F5Each performance share converts into one share of Common Stock upon vesting and settlement on January 3, 2017.