SEC Form 5 · accession 0001013631-16-000006

WORKIVA INC · WK

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — Chairman & CEO · Director · 10% Owner

Period of report

Dec 31, 2015

Accepted (ET)

Jan 21, 2016 · 4:43 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001445305

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Class A Common Stock^F2	Nov 11, 2015	C	150,000	—	A	150,000	I	By Trust
Class A Common Stock^F1	holding	—	—		—	160,000	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Class B Common Stock^F3	—	Apr 17, 2015	G	2,077,058	D	—	—	Class A Common Stock	2,077,058	0	I
Class B Common Stock^F3,F5	—	Apr 17, 2015	G	40,000	A	—	—	Class A Common Stock	40,000	101,630	I
Class B Common Stock^F3	—	Apr 17, 2015	G	2,017,058	A	—	—	Class A Common Stock	2,017,058	2,017,058	I
Class B Common Stock^F3,F2	—	Nov 11, 2015	C	150,000	D	—	—	Class A Common Stock	150,000	1,867,058	I
Employee Stock Option to Purchase Class A Common Stock^F6,F7	$15.83	holding	—	—	—	Aug 12, 2015	Aug 11, 2024	Class A Common Stock	178,200	178,200	D
Class B Common Stock^F3	—	holding	—	—	—	—	—	Class A Common Stock	885,109	885,109	I
Class B Common Stock^F3	—	holding	—	—	—	—	—	Class A Common Stock	662,467	662,467	I

F1Vests in three equal annual installments commencing on the first anniversary of the grant date.
F2The Class B Common Stock was converted into Class A Common Stock on a 1-for-1 basis and had no expiration date.
F3Each 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).
F4Gift of Class B Common Stock to personal and family trusts.
F5The reporting person no longer has a reportable beneficial interest in 30,815 shares of Class B Common Stock beneficially owned by his daughter and included in the reporting person's prior ownership reports.
F6Granted pursuant to 2009 Unit Incentive Plan.
F7Vests 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.