0001209191-18-002770.txt : 20180108 0001209191-18-002770.hdr.sgml : 20180108 20180108180603 ACCESSION NUMBER: 0001209191-18-002770 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180104 FILED AS OF DATE: 20180108 DATE AS OF CHANGE: 20180108 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TATE DAVID C CENTRAL INDEX KEY: 0001593933 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35882 FILM NUMBER: 18517455 MAIL ADDRESS: STREET 1: C/O BLACKHAWK NETWORK HOLDINGS, INC. STREET 2: 6220 STONERIDGE MALL ROAD CITY: PLEASANTON STATE: CA ZIP: 94588 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BLACKHAWK NETWORK HOLDINGS, INC CENTRAL INDEX KEY: 0001411488 STANDARD INDUSTRIAL CLASSIFICATION: FINANCE SERVICES [6199] IRS NUMBER: 432099257 STATE OF INCORPORATION: DE FISCAL YEAR END: 1230 BUSINESS ADDRESS: STREET 1: 6220 STONERIDGE MALL ROAD CITY: PLEASANTON STATE: CA ZIP: 94588 BUSINESS PHONE: 925-226-9990 MAIL ADDRESS: STREET 1: 6220 STONERIDGE MALL ROAD CITY: PLEASANTON STATE: CA ZIP: 94588 FORMER COMPANY: FORMER CONFORMED NAME: BLACKHAWK NETWORK HOLDINGS INC DATE OF NAME CHANGE: 20070904 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-01-04 0 0001411488 BLACKHAWK NETWORK HOLDINGS, INC HAWK 0001593933 TATE DAVID C 6220 STONERIDGE MALL RD PLEASANTON CA 94588 0 1 0 0 SVP, U.S. Retail Common Stock 2018-01-04 4 M 0 4537 0.00 A 40968 D Common Stock 2018-01-04 4 F 0 1885 36.00 D 39083 D Performance Share Units (PSU) 2018-01-04 4 M 0 4537 0.00 D 2018-01-04 2018-01-04 Common Stock 4537 0 D The Reporting Person acquired the shares upon settlement of the Performance Share Units certified on February 22, 2016. Shares tendered in payment of the tax withholding obligation. Represents the closing price of the common stock on the date of forfeiture. Represents the performance shares earned under the 2015 performance share award as of February 22, 2016, at which date the Compensation Committee certified the extent to which the 2015 performance criteria were met. Each earned performance share represents the contingent right to receive one share of the Issuer's common stock. Reflects a correction (due to rounding) in the number of performance share units earned upon satisfaction of the applicable performance criteria as certified by the Compensation Committee of the Issuer. /s/ SHELDON QUAN, Attorney-in-Fact 2018-01-08