SEC Form 4 · accession 0001104659-17-044114

Blue Apron Holdings, Inc. · APRN

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

Reporting owner

10% Owner

Period of report

Jul 5, 2017

Accepted (ET)

Jul 7, 2017 · 6:03 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001701114

Table I — non-derivative securities

No Table I lines on this filing.

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Class B Common Stock^F1	—	Jul 5, 2017	C	1,192,100	A	—	—	Class A Common Stock	1,192,100	1,192,100	D
Class B Common Stock^F1,F2	—	Jul 5, 2017	C	1,628,850	A	—	—	Class A Common Stock	1,628,850	1,628,850	I
Series A Preferred Stock^F3,F1	—	Jul 5, 2017	C	23,842	D	—	—	Class B Common Stock	1,192,100	0	D
Series A Preferred Stock^F2,F3,F1	—	Jul 5, 2017	C	32,577	D	—	—	Class B Common Stock	1,628,850	0	I

F1The Class B Common Stock is convertible into the issuer's Class A Common Stock on a one-for-one basis upon certain transfers of such shares and at the holder's election and has no expiration date.
F2Barry Salzberg is trustee of The Salzberg Family 2011 Trust. Mr. Salzberg disclaims beneficial ownership of the shares owned directly by The Salzberg Family 2011 Trust except to the extent of any pecuniary interest therein.
F3The Series A Preferred Stock converted into Class B Common Stock on a 50-for-one basis automatically upon the closing of the isuer's initial public offering of its Class A Common Stock without payment of consideration. The Series A Preferred Stock was convertible at any time at the holder's election and automatically upon the closing of the issuer's initial public offering of its Class A Common Stock. The shares had no expiration date.