Annual Statement of Changes in Beneficial Ownership (5)
February 10 2023 - 06:12PM
Edgar (US Regulatory)
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FORM 5
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response... 1.0 |
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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 * Dietzen Scott |
2. Issuer Name and Ticker or Trading
SymbolPure Storage, Inc. [PSTG] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
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|
(Last)
(First)
(Middle)
C/O PURE STORAGE, INC., 650 CASTRO ST, SUITE 400 |
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
2/5/2023
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(Street)
MOUNTAIN VIEW, CA 94041
(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership
(Instr. 4) |
|
Amount |
(A) or (D) |
Price |
|
Class A Common Stock |
6/28/2022 |
|
J |
347000 (1) |
D |
$0.00 |
0 |
I |
By Trust (2) |
|
Class A Common Stock |
6/28/2022 |
|
J |
173500 (3) |
A |
$0.00 |
173500 |
I |
By Trust (4) |
|
Class A Common Stock |
6/28/2022 |
|
J |
173500 (5) |
A |
$0.00 |
173500 |
I |
By Trust (6) |
|
Class A Common Stock |
|
|
|
|
|
|
96834 |
D |
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|
Class A Common Stock |
|
|
|
|
|
|
1718456 |
I |
By Trust (7) |
Table II - Derivative Securities Acquired, Disposed of, or
Beneficially Owned (e.g., puts, calls, warrants, options,
convertible securities)
|
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
(MM/DD/YYYY) |
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 at End of Issuer's Fiscal Year
(Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I)
(Instr. 4) |
11. Nature of Indirect Beneficial Ownership
(Instr. 4) |
|
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of
Responses: |
| (1) |
Substitution of assets
between the Dietzen Family 2014 Irrevocable Trust, the Willa Sloane
Dietzen GST Exempt Trust and the Davis Louis Dietzen GST Exempt
Trust. |
| (2) |
Shares are held by JP Morgan
Trust Company of Delaware, as Trustee of the Dietzen Family
Irrevocable Trust GST Exempt Trust under agreement dated March 25,
2014. |
| (3) |
Substitution of assets
between the Dietzen Family 2014 Irrevocable Trust and the Willa
Sloane Dietzen GST Exempt Trust. |
| (4) |
Shares are held by JP Morgan
Trust Company of Delaware, TTEE Willa Sloane Dietzen GST Exempt
Trust under agreement dated March 25, 2014. |
| (5) |
Substitution of assets
between the Dietzen Family 2014 Irrevocable Trust and the Davis
Louis Dietzen GST Exempt Trust. |
| (6) |
Shares are held by JP Morgan
Trust Company of Delaware, TTEE Davis Louis Dietzen GST Exempt
Trust under agreement dated March 25, 2014. |
| (7) |
Shares are held by Scott
Dietzen and Katherine Dietzen, Co-Trustees of the Dietzen Living
Trust, dated January 16, 2009. |
Reporting
Owners
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|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Dietzen Scott
C/O PURE STORAGE, INC.
650 CASTRO ST, SUITE 400
MOUNTAIN VIEW, CA 94041 |
X |
|
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Signatures
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/s/Todd Wheeler, attorney-in-fact |
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2/10/2023 |
| **Signature of Reporting
Person |
Date |
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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 control number. |
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