Statement of Changes in Beneficial Ownership (4)
November 15 2019 - 5:55PM
Edgar (US Regulatory)
FORM 4
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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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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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1. Name and Address of Reporting Person
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Hartz Kevin |
2. Issuer Name and Ticker or Trading Symbol
Eventbrite, Inc.
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EB
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O EVENTBRITE, INC., 155 5TH STREET, 7TH FLOOR |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/11/2019 |
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(Street)
SAN FRANCISCO, CA 94103
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Class A Common Stock | 11/11/2019 | | A(1) | | 614 | A | $0.00 | 614 | I | See Footnote (2) |
| Class A Common Stock | | | | | | | | 418490 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 | (3) | | | | | | | (3) | (3) | Class A Common Stock | 4273601 | | 4273601 | I | See Footnote (2) |
| Class B Common Stock | (3) | | | | | | | (3) | (3) | Class A Common Stock | 2627266 | | 2627266 | I | See Footnote (4) |
| Class B Common Stock | (3) | | | | | | | (3) | (3) | Class A Common Stock | 1000000 | | 1000000 | I | See Footnote (5) |
| Class B Common Stock | (3) | | | | | | | (3) | (3) | Class A Common Stock | 411026 | | 411026 | D | |
| Explanation of Responses: |
| (1) | Receipt of shares as part of a pro rata distribution-in-kind to the members of an investment fund. |
| (2) | The shares are owned by the Kevin Earnest Hartz & Julia D. Hartz, Trustees of the Hartz Family Revocable Trust dated 12/4/08 of which the Reporting Person is a co-trustee. |
| (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 has no expiration date. |
| (4) | The shares are owned by the Hartz 2008 Irrevocable Trust dated 9/15/08 of which the Reporting Person is a co-trustee. |
| (5) | The shares are held by Julia Hartz, who is the Chief Executive Officer of the Issuer and the spouse of the Reporting Person, and as such the shares may be deemed to be
beneficially held by the Reporting Person. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Hartz Kevin
C/O EVENTBRITE, INC.
155 5TH STREET, 7TH FLOOR
SAN FRANCISCO, CA 94103 | X | X |
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Signatures
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| /s/ Samantha Harnett Attorney-in-fact of the Reporting Person | | 11/15/2019 |
| **Signature of Reporting Person | Date |
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