SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Bergsma Gus

(Last) (First) (Middle)
C/O BENTLEY SYSTEMS, INCORPORATED
685 STOCKTON DRIVE

(Street)
EXTON PA 19341

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/01/2021
3. Issuer Name and Ticker or Trading Symbol
BENTLEY SYSTEMS INC [ BSY ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Revenue Officer
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Class B Common Stock 771,829(1) D
Class B Common Stock 28,466 I By 401(k) Plan
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options (Right to Buy) (2) 02/28/2022 Class B Common Stock 35,154 3.88 D
Stock Options (Right to Buy) (2) 02/28/2022 Class B Common Stock 65,836 3.88 D
Stock Options (Right to Buy) (3) 05/28/2023 Class B Common Stock 19,234 5.305 D
Stock Options (Right to Buy) (3) 05/28/2023 Class B Common Stock 74,766 5.305 D
Explanation of Responses:
1. Includes 25,810 restricted shares of Class B Common Stock of the Issuer ("Class B Common Stock") and 505,658 shares of Class B Common Stock issuable under the Issuer's deferred compensation plan.
2. These options are fully vested.
3. Reflects options that vest in four equal annual installments beginning on May 29, 2018.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney.
/s/ Michael T. Fischette as Attorney-in-Fact 12/10/2021
** 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 5 (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.
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Exhibit 24

 

POWER OF ATTORNEY

 

Know all by these presents that the undersigned does hereby make, constitute and appoint each of David R. Shaman, Michael T. Fischette and Mariel E. Quigley, or any one of them, as a true and lawful attorney-in-fact and agent of the undersigned, with full powers of substitution and revocation, for and in the name, place and stead of the undersigned (in the undersigned's individual capacity), to execute and deliver such forms that the undersigned may be required to file with the U.S. Securities and Exchange Commission as a result of the undersigned's ownership of or transactions in securities of Bentley Systems, Incorporated, a Delaware corporation (the “Company”) (i) pursuant to Section 16(a) of the Securities Exchange Act of 1934, as amended, including without limitation, statements on Form 3, Form 4 and Form 5 (including any amendments thereto), and (ii) in connection with any applications for EDGAR access codes or any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the Securities and Exchange Commission, including without limitation any Form ID application or Update Passphrase request. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with regard to the undersigned's ownership of or transactions in securities of the Company, unless earlier revoked in writing. The undersigned acknowledges that Michael T. Fischette and Mariel E. Quigley are not assuming any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934.

 

  By: /s/ Gus Bergsma
  Name: Gus Bergsma
   
  Date: November 29, 2021