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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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Benefitfocus, Inc.
[ BNFT ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
Chief Financial Officer |
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3. Date of Earliest Transaction
(Month/Day/Year) 12/20/2022
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction 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 |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
12/20/2022 |
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H
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238,720 |
D |
$0.00
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222,225 |
D |
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Common Stock |
12/20/2022 |
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J
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238,720
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A |
$0.00
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460,945 |
D |
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Common Stock |
12/20/2022 |
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F |
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109,860
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D |
$10.45
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351,085 |
D |
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Common Stock |
12/20/2022 |
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H
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49,033 |
D |
$0.00
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302,052 |
D |
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Common Stock |
12/20/2022 |
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J
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67,303
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A |
$0.00
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369,355 |
D |
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Common Stock |
12/20/2022 |
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F |
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30,980
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D |
$10.45
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338,375 |
D |
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Performance Restricted Stock Units |
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12/20/2022 |
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H
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8,900 |
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04/01/2023 |
Common Stock |
8,900 |
$0.00
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3,818
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D |
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Performance Restricted Stock Units |
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12/20/2022 |
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H
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9,370 |
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04/01/2026 |
Common Stock |
9,370 |
$0.00
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86,019
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D |
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Explanation of Responses: |
Remarks: |
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/s/ S. Halle Vakani, Attorney-in-Fact |
12/22/2022 |
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** 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. |
Represents certain previously awarded and unvested restricted stock units (the
"RSUs") which were replaced with the following grants of restricted stock to the
Reporting Person to mitigate impacts of Section 280G of the Internal Revenue
Code of 1986, as amended:
(a) 72 RSUs of the 290 RSUs granted to the Reporting Person on February 1, 2019
were cancelled and granted as restricted stock, all of which will vest as
originally scheduled on February 1, 2023;
(b) 237 RSUs of the 950 RSUs granted to the Reporting Person on April 1, 2019
were cancelled and granted as restricted stock, all of which will vest as
originally scheduled on April 1, 2023;
(c) 1,083 RSUs of the 4,331 RSUs granted to the Reporting Person on November 1,
2019 were cancelled and granted as restricted stock, all of which will vest as
originally scheduled on November 1, 2023;
(d) 1,182 RSUs of the 4,726 RSUs granted to the Reporting Person on January 1,
2020 were cancelled and granted as restricted stock, all of which will vest as
originally scheduled on January 1, 2023;
(e) 1,181 RSUs of the 4,726 RSUs granted to the Reporting Person on January 1,
2020 were cancelled and granted as restricted stock, all of which will vest as
originally scheduled on January 1, 2024;
(f) 3,671 RSUs of the 11,014 RSUs granted to the Reporting Person on May 1, 2020
were cancelled and granted as restricted stock, all of which will vest as
originally scheduled on May 1, 2023;
(g) 7,263 RSUs of the 21,789 RSUs granted to the Reporting Person on September
1, 2020 were cancelled and granted as restricted stock, all of which will vest
as originally scheduled on September 1, 2023;
(h) 5,991 RSUs of the 23,966 RSUs earned by the Reporting Person on April 1,
2021 were cancelled and granted as restricted stock, all of which will vest on
April 1, 2023, with the remaining 11,984 RSUs to vest as originally scheduled
beginning on April 1, 2024;
(i) 12,455 RSUs of the 49,817 RSUs granted to the Reporting Person on April 1,
2021 were cancelled and granted as restricted stock, all of which will vest on
April 1, 2023, with the remaining 24,907 RSUs to vest as originally scheduled
beginning on April 1, 2024;
(j) 9,370 performance RSUs (the "PRSUs") of the 95,389 PRSUs granted to the
Reporting Person on April 1, 2022 were cancelled and granted as restricted
stock, all of which will vest on April 1, 2023, with the remaining PRSUs to vest
as set forth in footnotes 6 and 7 of this Form 4;
(k) 8,900 PRSUs of the 12,718 PRSUs granted to the Reporting Person on April 1,
2022 were cancelled and granted as restricted stock, all of which will vest on
the date on which the Issuer's Restricted Stock Interests Committee certifies
achievement of the applicable short-term incentive performance goals for the
original grant of PRSUs, with the remaining PRSUs to vest as set forth in
footnote 5 of this Form 4; and
(l) 15,898 RSUs of the 63,593 RSUs granted to the Reporting Person on April 1,
2022 were cancelled and granted as restricted stock, all of which will vest on
April 1, 2023, with the remaining 47,695 RSUs to vest as originally scheduled
beginning on April 1, 2024.
The restricted stock set forth above is subject to the Reporting Person's
continuous service. Vesting of such restricted stock above may accelerate in
certain circumstances, including if the Reporting Person is terminated without
Cause or for Good Reason (in each case as defined in Reporting Person's
employment agreement).