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
 
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
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*
Keane Robert S

(Last) (First) (Middle)
CIMPRESS N.V.
BUILDING D, XEROX TECHNOLOGY PARK

(Street)
DUNDALK, COUNTY LOUTH, IRELAND

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CIMPRESS N.V. [ CMPR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CEO, Chairman
3. Date of Earliest Transaction (Month/Day/Year)
05/03/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
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. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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)
Code V Amount (A) or (D) Price
Ordinary Shares 05/03/2019 M(1) 73,014 A $34.25 414,284(2) I By Eastern Irrevocable, LLC
Ordinary Shares 05/03/2019 F(1) 47,220 D $89.07 367,064(2) I By Eastern Irrevocable, LLC
Ordinary Shares 05/03/2019 M(1) 73,014 A $34.25 414,244(2) I By Western Irrevocable, LLC
Ordinary Shares 05/03/2019 F(1) 47,220 D $89.07 367,024(2) I By Western Irrevocable, LLC
Ordinary Shares 91,181 I By Keane Family Foundation
Ordinary Shares 36,875 I By RHS Holdings Incorporated
Ordinary Shares 51,900 I By Delaware 2001, LLC
Ordinary Shares 390,000 I By First Delaware 2003, LLC
Ordinary Shares 390,000 I By Second Delaware 2003, LLC
Ordinary Shares 185,000 I By Third Delaware 2011, LLC
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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 Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Option (right to buy) $34.25 05/03/2019 M(1) 73,014 05/07/2010(3) 05/07/2019 Ordinary Shares 73,014 $0 0 I By Eastern Irrevocable, LLC
Option (right to buy) $34.25 05/03/2019 M(1) 73,014 05/07/2010(3) 05/07/2019 Ordinary Shares 73,014 $0 0 I By Western Irrevocable, LLC
Explanation of Responses:
1. The transactions reported on this Form 4 were effected pursuant to a 10b5-1 trading plan adopted by the reporting person on November 27, 2018.
2. Includes 36,875 shares held by RHS Holdings Incorporated, of which Eastern Irrevocable, LLC and Western Irrevocable, LLC are the sole shareholders.
3. This option became exercisable as to 25% of the original number of shares on the Exercisable Date shown on Table II, and as to an additional 6.25% of the original number of shares at the end of each successive three-month period thereafter.
Remarks:
/s/Kathryn L. Leach, as attorney-in fact-for Robert Keane 05/06/2019
** 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.