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*
Banarjee Mithun

(Last) (First) (Middle)
2900 UNIVERSITY BOULEVARD

(Street)
AMES IA 50010

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
WORKIVA INC [ WK ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP and Chief Customer Officer
3. Date of Earliest Transaction (Month/Day/Year)
02/01/2019
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
Class A Common Stock 02/01/2019 A(1) 26,278(2) A $41.86 138,638 D
Class A Common Stock 02/01/2019 F(3) 369 D $41.86 138,269 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
Employee Stock Option to Purchase Class A Common Stock(4) $2.53 03/25/2012(5) 11/01/2021 Class A Common Stock 9,900 9,900 D
Employee Stock Option to Purchase Class A Common Stock(4) $15.86 01/14/2014(6) 01/13/2024 Class A Common Stock 1,149 1,149 D
Employee Stock Option to Purchase Class A Common Stock(4) $15.86 01/14/2015(5) 01/13/2024 Class A Common Stock 11,880 11,880 D
Employee Stock Option to Purchase Class A Common Stock(4) $15.83 11/01/2015(5) 11/05/2024 Class A Common Stock 13,860 13,860 D
Employee Stock Option to Purchase Class A Common Stock(7) $14.07 04/01/2016(5) 03/31/2025 Class A Common Stock 16,000 16,000 D
Employee Stock Option to Purchase Class A Common Stock(7) $16.66 01/04/2017(5) 01/03/2026 Class A Common Stock 40,000 40,000 D
Employee Stock Option to Purchase Class A Common Stock(7) $14.28 07/01/2017(5) 07/31/2026 Class A Common Stock 20,000 20,000 D
Employee Stock Option to Purchase Class A Common Stock(7) $13.55 01/03/2018(5) 01/02/2027 Class A Common Stock 22,000 22,000 D
Explanation of Responses:
1. Grant of restricted stock units pursuant to the 2014 Equity Incentive Plan.
2. Vests in three equal annual installments commencing on the first anniversary of the grant date.
3. Shares delivered to the issuer for the payment of witholding taxes due upon the vesting of restricted stock units previously granted.
4. Granted pursuant to the 2009 Unit Incentive Plan.
5. Vests 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.
6. Fully vested on upon the grant date.
7. Grant of stock option pursuant to the 2014 Equity Incentive Plan.
Remarks:
/s/ Troy M. Calkins as attorney-in-fact for Mithun Banarjee 02/05/2019
** 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.