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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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OMB APPROVAL
OMB Number: 3235-0287 Estimated average burden hours per response... 0.5 |
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1. Name and Address of Reporting Person
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Koum Jan |
2. Issuer Name
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Ticker or Trading Symbol
Facebook Inc [ FB ] |
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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C/O FACEBOOK, INC., 1601 WILLOW ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
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MENLO PARK, CA 94025 |
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 |
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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 | 11/19/2015 | S (1) | 306861 | D | $106.4892 (2) | 52572474 (3) | I | By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004 (4) | ||
| Class A Common Stock | 11/19/2015 | S (1) | 208418 | D | $107.1822 (5) | 52364056 | I | By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004 (4) | ||
| Class A Common Stock | 11/20/2015 | S (1) | 426171 | D | $107.2186 (6) | 51937885 | I | By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004 (4) | ||
| Class A Common Stock | 11/20/2015 | S (1) | 89108 | D | $107.70 (7) | 51848777 | I | By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004 (4) | ||
| Class A Common Stock | 11/23/2015 | S (1) | 428801 | D | $106.749 (8) | 51419976 | I | By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004 (4) | ||
| Class A Common Stock | 11/23/2015 | S (1) | 86478 | D | $107.2138 (9) | 51333498 | I | By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004 (4) | ||
| Class A Common Stock | 3442873 | I | By Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust IV U/A/D 2/4/2015 (10) | |||||||
| Class A Common Stock | 3500000 | I | By Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust V U/A/D 4/29/2015 (11) | |||||||
| Class A Common Stock | 3500000 | I | By Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust VI U/A/D 8/5/2015 (12) | |||||||
| Class A Common Stock | 3500000 | I | By Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust VII U/A/D 10/20/2015 (13) | |||||||
| Class A Common Stock | 141489 | I | By Jan Koum, Trustee of The Jan Koum Trust I U/A/D 4/29/2014 (14) | |||||||
| Class A Common Stock | 141489 | I | By Jan Koum, Trustee of The Jan Koum Trust II U/A/D 8/5/2014 (15) | |||||||
| Class A Common Stock | 2528672 | I | By Jan Koum, Trustee of The Jan Koum Trust III U/A/D 10/9/2014 (16) | |||||||
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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 | ||||||||
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Reporting Owners
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| Reporting Owner Name / Address |
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| Director | 10% Owner | Officer | Other | ||
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Koum Jan
C/O FACEBOOK, INC. 1601 WILLOW ROAD MENLO PARK, CA 94025 |
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Signatures
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| /s/ Michael Johnson as attorney-in-fact for Jan Koum | 11/23/2015 | |
| ** 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. | |