0001864306-22-000005.txt : 20220210 0001864306-22-000005.hdr.sgml : 20220210 20220210170608 ACCESSION NUMBER: 0001864306-22-000005 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211231 FILED AS OF DATE: 20220210 DATE AS OF CHANGE: 20220210 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Gardner Jason M. CENTRAL INDEX KEY: 0001864306 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40465 FILM NUMBER: 22615157 MAIL ADDRESS: STREET 1: C/O MARQETA, INC. STREET 2: 180 GRAND AVE., FLR 6 CITY: OAKLAND STATE: CA ZIP: 94612 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Marqeta, Inc. CENTRAL INDEX KEY: 0001522540 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 274306690 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 180 GRAND AVENUE STREET 2: 6TH FLOOR CITY: OAKLAND STATE: CA ZIP: 94612 BUSINESS PHONE: 888-462-7738 MAIL ADDRESS: STREET 1: 180 GRAND AVENUE STREET 2: 6TH FLOOR CITY: OAKLAND STATE: CA ZIP: 94612 5 1 wf-form5_164453074945624.xml FORM 5 X0306 5 2021-12-31 0 0 0 0001522540 Marqeta, Inc. MQ 0001864306 Gardner Jason M. 180 GRAND AVENUE 6TH FLOOR OAKLAND CA 94612 1 1 1 0 Chief Executive Officer Class B Common Stock 2021-12-06 5 G 0 156463 0 D Class A Common Stock 156463.0 468537 I See Footnote Class B Common Stock 2021-12-06 5 G 0 156463 0 D Class A Common Stock 156463.0 468537 I See Footnote Class B Common Stock Class A Common Stock 40235479.0 40235479 I See Footnote Class B Common Stock Class A Common Stock 8000000.0 8000000 I See Footnote 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. On December 2, 2021, the Jason Gardner 2020 GRAT, dated November 23, 2020, of which the Reporting Person is trustee, transferred 156,463 shares of Class B common Stock to The Gardner 2008 Living Trust dated March 22, 2008, of which the Reporting Person and his spouse are trustees. The shares are held of record by the Reporting Person, as trustee of the Jason Gardner 2020 GRAT, dated November 23, 2020. On December 2, 2021, the Jocelyne Gardner 2020 GRAT, dated November 23, 2020, of which the Reporting Person's spouse is trustee, transferred 156,463 shares of Class B common Stock to The Gardner 2008 Living Trust dated March 22, 2008, of which the Reporting Person and his spouse are trustees. The shares are held of record by the spouse of the Reporting Person, as trustee of the Jocelyne Gardner 2020 GRAT, dated November 23, 2020. The shares are held of record by the Reporting Person and his spouse as trustees of The Gardner 2008 Living Trust dated March 22, 2008. 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. /s/ Christine Paster, Attorney-in-Fact 2022-02-10