SEC FORM 5 SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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 Number: 3235-0362
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hours per response: 1.0
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.
X
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
Keane Robert S

(Last) (First) (Middle)
CIMPRESS PLC
BUILDING D, XEROX TECHNOLOGY PARK

(Street)
DUNDALK, COUNTY LOUTH, IRELAND

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CIMPRESS plc [ 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. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
06/30/2022
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 at end of Issuer's Fiscal Year (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
Ordinary Shares 10/12/2021 S4(1) 300,000 D $83.04 88,128(2) I By Eastern Irrevocable, LLC
Ordinary Shares 10/12/2021 P4(1) 300,000 A $83.04 668,200(3) I By Third Delaware 2011 GST-Exempt Trust
Ordinary Shares 10/12/2021 S4(1) 300,000 D $83.04 92,088(2) I By Western Irrevocable, LLC
Ordinary Shares 10/12/2021 P4(1) 300,000 A $83.04 968,200(3) I By Third Delaware 2011 GST-Exempt Trust
Ordinary Shares 800 D
Ordinary Shares 109,181 I By Keane Family Foundation
Ordinary Shares 28,375 I By RHS Delaware Holdings LLC
Ordinary Shares 86,861 I By RSK - Foundation Charitable Lead Annuity Trust u/d/t dated 5/5/2020
Ordinary Shares 86,861 I By HKLMK - Foundation Charitable Trust Lead Annuity Trust u/d/t dated 5/5/2020
Ordinary Shares 51,900 I By Delaware 2001, LLC
Ordinary Shares 780,000 I By Second Delaware 2003, LLC
Ordinary Shares 368,200 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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. These purchases and sales are internal transactions for the Reporting Person's estate planning purposes among trusts and companies that are controlled by the Reporting Person.
2. Includes 28,375 shares held by RHS Holdings Incorporated, of which The Eastern Irrevocable Trust and The Western Irrevocable Trust are the sole shareholders.
3. Includes 368,200 shares held by Third Delaware 2011, LLC, of which the Third Delaware 2011 GST-Exempt Trust is the sole shareholder.
Remarks:
/s/Kathryn L. Leach, as attorney-in fact-for Robert Keane 07/15/2022
** 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.