FORM 4
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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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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1. Name and Address of Reporting Person
*
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2. Issuer Name
and
Ticker or Trading Symbol
Facebook Inc [ FB ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__ X __ Director __ X __ 10% Owner _____ Officer (give title below) _____ Other (specify below) |
C/O ACCEL PARTNERS, 428 UNIVERSITY AVENUE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
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PALO ALTO, CA 94301 |
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 |
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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) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Class A Common Stock | 5/22/2012 | C | 10844263 | A | $0.00 | 10844263 | I | By James W. Breyer as Trustee of James W. Breyer 2005 Trust dated March 25, 2005 (1) | ||
Class A Common Stock | 5/22/2012 | S | 3375545 | D | $37.58 | 7468718 | I | By James W. Breyer as Trustee of James W. Breyer 2005 Trust dated March 25, 2005 (1) | ||
Class A Common Stock | 5/22/2012 | C | 704263 | A | $0.00 | 704263 | I | By James W. Breyer as Trustee of James W. Breyer 2011 Annuity Trust 1, dated March 10, 2011 (2) | ||
Class A Common Stock | 5/22/2012 | C | 149527730 | A | $0.00 | 149527730 | I | By Accel IX L.P. (3) | ||
Class A Common Stock | 5/22/2012 | S | 43216317 | D | $37.58 | 106311413 | I | By Accel IX L.P. (3) | ||
Class A Common Stock | 5/22/2012 | C | 15931653 | A | $0.00 | 15931653 | I | By Accel IX Strategic Partners L.P. (4) | ||
Class A Common Stock | 5/22/2012 | S | 4604228 | D | $37.58 | 11327425 | I | By Accel IX Strategic Partners L.P. (4) | ||
Class A Common Stock | 5/22/2012 | C | 13939214 | A | $0.00 | 13939214 | I | By Accel Investors 2005 L.L.C. (5) | ||
Class A Common Stock | 5/22/2012 | S | 4028678 | D | $37.58 | 9910536 | I | By Accel Investors 2005 L.L.C. (5) | ||
Class A Common Stock | 5/22/2012 | C | 2422564 | A | $0.00 | 2422564 | I | By Accel Growth Fund L.P. (6) | ||
Class A Common Stock | 5/22/2012 | S | 2422564 | D | $37.58 | 0 | I | By Accel Growth Fund L.P. (6) | ||
Class A Common Stock | 5/22/2012 | C | 47291 | A | $0.00 | 47291 | I | By Accel Growth Fund Strategic Partners L.P. (7) | ||
Class A Common Stock | 5/22/2012 | S | 47291 | D | $37.58 | 0 | I | By Accel Growth Fund Strategic Partners L.P. (7) | ||
Class A Common Stock | 5/22/2012 | C | 32278 | A | $0.00 | 32278 | I | By Accel Growth Fund Investors 2009 L.L.C. (8) | ||
Class A Common Stock | 5/22/2012 | S | 32278 | D | $37.58 | 0 | I | By Accel Growth Fund Investors 2009 L.L.C. (8) |
Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities) |
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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 |
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 of Derivative Security: 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 | ||||||||
Series B Convertible Preferred Stock (9) | (9) | 5/22/2012 | C | 10161282 | (9) | (9) | Class B Common Stock (10) | 10211171 | $0.00 | 0 | I | By James W. Breyer as Trustee of James W. Breyer 2005 Trust dated March 25, 2005 (1) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 10211171 | (10) | (10) | Class A Common Stock | 10211171 | $0.00 | 10350315 | I | By James W. Breyer as Trustee of James W. Breyer 2005 Trust dated March 25, 2005 (1) | |||
Series C Convertible Preferred Stock (11) | (11) | 5/22/2012 | C | 630000 | (11) | (11) | Class B Common Stock (10) | 633092 | $0.00 | 0 | I | By James W. Breyer as Trustee of James W. Breyer 2005 Trust dated March 25, 2005 (1) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 633092 | (10) | (10) | Class A Common Stock | 633092 | $0.00 | 10983407 | I | By James W. Breyer as Trustee of James W. Breyer 2005 Trust dated March 25, 2005 (1) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 10844263 | (10) | (10) | Class A Common Stock (12) | 108442643 | $0.00 | 139144 | I | By James W. Breyer as Trustee of James W. Breyer 2005 Trust dated March 25, 2005 (1) | |||
Series B Convertible Preferred Stock (9) | (9) | 5/22/2012 | C | 630823 | (9) | (9) | Class B Common Stock (10) | 633920 | $0.00 | 0 | I | By James W. Breyer as Trustee of James W. Breyer 2011 Annuity Trust 1, dated March 10, 2011 (2) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 633920 | (10) | (10) | Class A Common Stock | 633920 | $0.00 | 649381 | I | By James W. Breyer as Trustee of James W. Breyer 2011 Annuity Trust 1, dated March 10, 2011 (2) | |||
Series C Convertible Preferred Stock (11) | (11) | 5/22/2012 | C | 70000 | (11) | (11) | Class B Common Stock (10) | 70343 | $0.00 | 0 | I | By James W. Breyer as Trustee of James W. Breyer 2011 Annuity Trust 1, dated March 10, 2011 (2) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 70343 | (10) | (10) | Class A Common Stock | 70343 | $0.00 | 719724 | I | By James W. Breyer as Trustee of James W. Breyer 2011 Annuity Trust 1, dated March 10, 2011 (2) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 704263 | (10) | (10) | Class A Common Stock (12) | 704263 | $0.00 | 15461 | I | By James W. Breyer as Trustee of James W. Breyer 2011 Annuity Trust 1, dated March 10, 2011 (2) | |||
Series B Convertible Preferred Stock (9) | (9) | 5/22/2012 | C | 139733902 | (9) | (9) | Class B Common Stock (10) | 140419959 | $0.00 | 0 | I | By Accel IX L.P. (3) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 140419959 | (10) | (10) | Class A Common Stock | 140419959 | $0.00 | 140419959 | I | By Accel IX L.P. (3) | |||
Series C Convertible Preferred Stock (11) | (11) | 5/22/2012 | C | 9063280 | (11) | (11) | Class B Common Stock (10) | 9107771 | $0.00 | 0 | I | By Accel IX L.P. (3) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 9107771 | (10) | (10) | Class A Common Stock | 9107771 | $0.00 | 149527730 | I | By Accel IX L.P. (3) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 149527730 | (10) | (10) | Class A Common Stock (12) | 149527730 | $0.00 | 0 | I | By Accel IX L.P. (3) | |||
Series B Convertible Preferred Stock (9) | (9) | 5/22/2012 | C | 14888296 | (9) | (9) | Class B Common Stock (10) | 14961394 | $0.00 | 0 | I | By Accel IX Strategic Partners L.P. (4) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 14961394 | (10) | (10) | Class A Common Stock | 14961394 | $0.00 | 14961394 | I | By Accel IX Strategic Partners L.P. (4) | |||
Series C Convertible Preferred Stock (11) | (11) | 5/22/2012 | C | 965520 | (11) | (11) | Class B Common Stock (10) | 970259 | $0.00 | 0 | I | By Accel IX Strategic Partners L.P. (4) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 970259 | (10) | (10) | Class A Common Stock | 970259 | $0.00 | 15931653 | I | By Accel IX Strategic Partners L.P. (4) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 15931653 | (10) | (10) | Class A Common Stock (12) | 15931653 | $0.00 | 0 | I | By Accel IX Strategic Partners L.P. (4) | |||
Series B Convertible Preferred Stock (9) | (9) | 5/22/2012 | C | 13026232 | (9) | (9) | Class B Common Stock (10) | 13090187 | $0.00 | 0 | I | By Accel Investors 2005 L.L.C. (5) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 13090187 | (10) | (10) | Class A Common Stock | 13090187 | $0.00 | 13090187 | I | By Accel Investors 2005 L.L.C. (5) | |||
Series C Convertible Preferred Stock (11) | (11) | 5/22/2012 | C | 844880 | (11) | (11) | Class B Common Stock (10) | 849027 | $0.00 | 0 | I | By Accel Investors 2005 L.L.C. (5) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 849027 | (10) | (10) | Class A Common Stock | 849027 | $0.00 | 13939214 | I | By Accel Investors 2005 L.L.C. (5) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 13939214 | (10) | (10) | Class A Common Stock (12) | 13939214 | $0.00 | 0 | I | By Accel Investors 2005 L.L.C. (5) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 2422564 | (10) | (10) | Class A Common Stock (13) | 2422564 | $0.00 | 7527256 | I | By Accel Growth Fund L.P. (6) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 47291 | (10) | (10) | Class A Common Stock (13) | 47291 | $0.00 | 146939 | I | By Accel Growth Fund Strategic Partners L.P. (7) | |||
Class B Common Stock (10) | (10) | 5/22/2012 | C | 32278 | (10) | (10) | Class A Common Stock (13) | 32278 | $0.00 | 100292 | I | By Accel Growth Fund Investors 2009 L.L.C. (8) |
Reporting Owners
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Reporting Owner Name / Address |
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Director | 10% Owner | Officer | Other | ||
BREYER JAMES
C/O ACCEL PARTNERS 428 UNIVERSITY AVENUE PALO ALTO, CA 94301 |
X | X |
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Signatures
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/s/ Michael Johnson as attorney-in-fact for James W. Breyer | 5/22/2012 | |
** 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. |
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