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*
Weissman Seth R

(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)
Director 10% Owner
X Officer (give title below) Other (specify below)
See Remarks
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 J(1) 68,493 D (2) 0 D
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
Class B Common Stock (2) 06/11/2021 J(1) 68,493 (2) (2) Class A Common Stock 68,493 $0.00 68,493 D
Stock Option (Right to Buy) $1.46 06/11/2021 J(1) 1,415,675 (3) 06/04/2029 Common Stock 1,415,675 $0.00 0 D
Stock Option (Right to Buy) $1.46 06/11/2021 J(1) 1,415,675 (3) 06/04/2029 Class B Common Stock(2) 1,415,675 $0.00 1,415,675 D
Stock Option (Right to Buy) $2.25 06/11/2021 J(1) 300,000 (4) 05/04/2030 Common Stock 300,000 $0.00 0 D
Stock Option (Right to Buy) $2.25 06/11/2021 J(1) 300,000 (4) 05/04/2030 Class B Common Stock(2) 300,000 $0.00 300,000 D
Stock Option (Right to Buy) $10.48 06/11/2021 J(1) 236,198 (5) 02/10/2031 Common Stock 236,198 $0.00 0 D
Stock Option (Right to Buy) $10.48 06/11/2021 J(1) 236,198 (5) 02/10/2031 Class B Common Stock(2) 236,198 $0.00 236,198 D
Stock Option (Right to Buy) $10.48 06/11/2021 J(1) 150,000 (6) 02/10/2031 Common Stock 150,000 $0.00 0 D
Stock Option (Right to Buy) $10.48 06/11/2021 J(1) 150,000 (6) 02/10/2031 Class B Common Stock(2) 150,000 $0.00 150,000 D
Explanation of Responses:
1. 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.
2. 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.
3. The stock option vested with respect to 25% of the shares on April 29, 2020 and vests in 36 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.
4. 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.
5. 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.
6. 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.
Remarks:
Chief Legal Officer, General Counsel, and Secretary
/s/ Seth Weissman 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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