0001104659-20-114992.txt : 20201014
0001104659-20-114992.hdr.sgml : 20201014
20201014173026
ACCESSION NUMBER: 0001104659-20-114992
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201009
FILED AS OF DATE: 20201014
DATE AS OF CHANGE: 20201014
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Salzberg Matthew B
CENTRAL INDEX KEY: 0001710351
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38134
FILM NUMBER: 201239718
MAIL ADDRESS:
STREET 1: 5 CROSBY STREET
CITY: NEW YORK
STATE: NY
ZIP: 10013
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Blue Apron Holdings, Inc.
CENTRAL INDEX KEY: 0001701114
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-CATALOG & MAIL-ORDER HOUSES [5961]
IRS NUMBER: 814777373
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 28 LIBERTY STREET
CITY: NEW YORK
STATE: NY
ZIP: 10005
BUSINESS PHONE: 347-719-4312
MAIL ADDRESS:
STREET 1: 28 LIBERTY STREET
CITY: NEW YORK
STATE: NY
ZIP: 10005
4
1
a4.xml
4
X0306
4
2020-10-09
0
0001701114
Blue Apron Holdings, Inc.
APRN
0001710351
Salzberg Matthew B
C/O BLUE APRON HOLDINGS, INC.
28 LIBERTY STREET
NEW YORK
NY
10005
1
0
1
0
Class A Common Stock
2020-10-09
4
C
0
100000
0
A
128631
D
Class B Common Stock
2020-10-09
4
C
0
100000
0
D
Class A Common Stock
100000
1215161
D
Class B Common Stock
Class A Common Stock
1316272
1316272
I
See footnote
Class B Common Stock
Class A Common Stock
1250
1250
I
See footnote
Class B Common Stock
Class A Common Stock
166666
166666
I
By The Matthew Salzberg Family 2014 Trust
Class B Common Stock
Class A Common Stock
180906
180906
I
By MS 2018 Trust I
Class B Common Stock
Class A Common Stock
180906
180906
I
By MS 2018 Trust II
Represents the number of shares that were acquired upon conversion of the shares of Class B Common Stock into Class A Common Stock listed in Table II.
The Class B Common Stock is convertible into the issuer's Class A Common Stock on a 1-for-1 basis upon certain transfers of such shares and at the holder's election and has no expiration date.
The holder elected to convert the shares of Class B Common Stock into Class A Common Stock on a 1-for-1 basis.
Represents the shares of Class B Common Stock owned of record by Family Trust Created Under Article V of the Matthew Salzberg 2014 Annuity Trust Agreement and beneficially owned by Matthew B. Salzberg. Mr. Salzberg has investment control over any securities owned by Family Trust Created Under Article V of The Matthew Salzberg 2014 Annuity Trust Agreement and beneficially owned by Matthew B. Salzberg. Mr. Salzberg disclaims beneficial ownership of the shares owned directly by Family Trust Created Under Article V of The Matthew Salzberg 2014 Annuity Trust Agreement except to the extent of any pecuniary interest therein.
Represents the shares of Class B Common Stock owned of record by Aspiration Growth Opportunities II GP, LLC, with respect to which Matthew B. Salzberg has shared investment and voting power. Mr. Salzberg disclaims beneficial ownership of the shares owned directly by Aspiration Growth Opportunities II GP, LLC except to the extent of any pecuniary interest therein.
Matthew B. Salzberg is trustee of The Matthew Salzberg Family 2014 Trust. Mr. Salzberg disclaims beneficial ownership of the shares owned directly by The Matthew Salzberg Family 2014 Trust except to the extent of any pecuniary interest therein.
Matthew B. Salzberg is co-trustee of, and exercises sole investment control with respect to shares held by, MS 2018 Trust I. Mr. Salzberg disclaims beneficial ownership of the shares owned directly by MS 2018 Trust I except to the extent of any pecuniary interest therein.
Matthew B. Salzberg is co-trustee of, and exercises sole investment control with respect to shares held by, MS 2018 Trust II. Mr. Salzberg disclaims beneficial ownership of the shares owned directly by MS 2018 Trust II except to the extent of any pecuniary interest therein.
/s/ Meredith Deutsch, as attorney-in-fact for Matthew B. Salzberg
2020-10-14