SEC FORM 4 SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Gardner Jason M.

(Last) (First) (Middle)
180 GRAND AVENUE, 6TH FLOOR

(Street)
OAKLAND CA 94612

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Marqeta, Inc. [ MQ ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
3. Date of Earliest Transaction (Month/Day/Year)
06/11/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 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
Common Stock 06/11/2021 C(1) 274,350 A (1) 39,922,553 I See Footnote(4)
Common Stock 06/11/2021 J(2) 39,922,553 D (3) 0 I See Footnote(4)
Common Stock 06/11/2021 J(2) 625,000 D (3) 0 I See Footnote(5)
Common Stock 06/11/2021 J(2) 625,000 D (3) 0 I See Footnote(6)
Common Stock 06/11/2021 J(2) 8,000,000 D (3) 0 I See Footnote(7)
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 (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 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 (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (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: 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
Series A Preferred Stock (1) 06/11/2021 C(1) 274,350 (1) (1) Common Stock 274,350 $0.00 0 I See Footnote(4)
Class B Common Stock (3) 06/11/2021 J(2) 39,922,553 (3) (3) Class A Common Stock 39,922,553 $0.00 39,922,553 I See Footnote(4)
Class B Common Stock (3) 06/11/2021 J(2) 625,000 (3) (3) Class A Common Stock 625,000 $0.00 625,000 I See Footnote(5)
Class B Common Stock (3) 06/11/2021 J(2) 625,000 (3) (3) Class A Common Stock 625,000 $0.00 625,000 I See Footnote(6)
Class B Common Stock (3) 06/11/2021 J(2) 8,000,000 (3) (3) Class A Common Stock 8,000,000 $0.00 8,000,000 I See Footnote(7)
Stock Option (Right to Buy) $0.4 06/11/2021 J(2) 770,557 (8) 02/23/2029 Common Stock 770,557 $0.00 0 D
Stock Option (Right to Buy) $0.4 06/11/2021 J(2) 770,557 (8) 02/23/2029 Class B Common Stock(3) 770,557 $0.00 770,557 D
Stock Option (Right to Buy) $2.25 06/11/2021 J(2) 458,334 (9) 05/04/2030 Common Stock 458,334 $0.00 0 D
Stock Option (Right to Buy) $2.25 06/11/2021 J(2) 458,334 (9) 05/04/2030 Class B Common Stock(3) 458,334 $0.00 458,334 D
Stock Option (Right to Buy) $10.48 06/11/2021 J(2) 1,059,639 (10) 02/10/2031 Common Stock 1,059,639 $0.00 0 D
Stock Option (Right to Buy) $10.48 06/11/2021 J(2) 1,059,639 (10) 02/10/2031 Class B Common Stock(3) 1,059,639 $0.00 1,059,639 D
Stock Option (Right to Buy) $10.48 06/11/2021 J(2) 150,000 (11) 02/10/2031 Common Stock 150,000 $0.00 0 D
Stock Option (Right to Buy) $10.48 06/11/2021 J(2) 150,000 (11) 02/10/2031 Class B Common Stock(3) 150,000 $0.00 150,000 D
Stock Option (Right to Buy) $21.49 06/11/2021 J(2) 19,740,923 (12) 04/12/2031 Common Stock 19,740,923 $0.00 0 D
Stock Option (Right to Buy) $21.49 06/11/2021 J(2) 19,740,923 (12) 04/12/2031 Class B Common Stock(3) 19,740,923 $0.00 19,740,923 D
Stock Option (Right to Buy) $23.4 06/11/2021 J(2) 47,267 (12) 05/04/2031 Common Stock 47,267 $0.00 0 D
Stock Option (Right to Buy) $23.4 06/11/2021 J(2) 47,267 (12) 05/04/2031 Class B Common Stock(3) 47,267 $0.00 47,267 D
Explanation of Responses:
1. Immediately prior to the closing of the Issuer's initial public offering, each share of Preferred Stock automatically converted into one share of the Issuer's Common Stock on a one-for-one basis. The Preferred Stock had no expiration date.
2. Immediately prior to the closing of the Issuer's initial public offering and following the conversion of each series of the Issuer's Preferred Stock into Common Stock, each share of Common Stock was reclassified into one share of Class B Common Stock in an exempt transaction pursuant to Rule 16b-7 and Rule 16b-3.
3. Each share of Class B Common Stock is convertible into one share of Class A Common Stock at the option of the holder and upon the occurrence of other events set forth in the Issuer's Certificate of Incorporation.
4. The shares are held of record by Jason Gardner and Jocelyne Gardner as trustees of The Gardner 2008 Living Trust dated March 22, 2008.
5. The shares are held of record by Jason Gardner, as trustee of the Jason Gardner 2020 GRAT, dated November 23, 2020.
6. The shares are held of record by Jocelyne Gardner, the spouse of the Reporting Person, as trustee of the Jocelyne Gardner 2020 GRAT, dated November 23, 2020.
7. The shares are held of record by trusts for the benefit of the Reporting Person's children and of which the trustee is an independent institution. The Reporting Person disclaims beneficial ownership of the shares held in the trusts for the benefit of the Reporting Person's children.
8. The stock option vests in 48 monthly installments after February 24, 2019, subject to the Reporting Person's continued service to the Issuer as of each vesting date. The stock option is early exercisable by the Reporting Person.
9. The stock option vests in 48 monthly installments after April 1, 2020, subject to the Reporting Person's continued service to the Issuer as of each vesting date. The stock option is early exercisable by the Reporting Person.
10. The stock option shall vest with respect to 50% of the shares on January 1, 2023, and shall vest in 24 additional monthly installments thereafter, subject to the Reporting Person's continued service to the Issuer as of each vesting date. The stock option is early exercisable by the Reporting Person.
11. The stock option vests in 48 monthly installments after January 1, 2021, subject to the Reporting Person's continued service to the Issuer as of each vesting date. The stock option is early exercisable by the Reporting Person.
12. The stock option represents a long-term performance award as further described in the Issuer's registration statement on Form S-1 (File No. 333-256154). The stock option vests in up to seven equal tranches contingent upon the Issuer achieving certain common stock price targets over a period ending on the seven year anniversary of the date of the Issuer's initial public offering, but only up to 20% of the stock option may vest during the first four years following the Issuer's initial public offering. The vesting of the option is subject to the Reporting Person's continued service with the Issuer as of each such vesting date.
Remarks:
/s/ Seth Weissman, Attorney-in-Fact 06/15/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** 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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