FORM 3
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Washington, D.C. 20549 |
OMB APPROVAL
OMB Number: 3235-0104 Estimated average burden hours per response... 0.5 |
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1. Name and Address of Reporting Person
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2. Date of Event Requiring Statement (MM/DD/YYYY)
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3. Issuer Name and Ticker or Trading Symbol Facebook Inc [FB] |
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
_____ Officer (give title below) _____ Other (specify below) |
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities) |
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1. Title of Derivate Security
(Instr. 4) |
2. Date Exercisable and Expiration Date
(MM/DD/YYYY) |
3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) |
6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series D Preferred Stock | (1) | (1) | Class A Common Stock | 32784639 | (1) | D |
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Remarks:
Following the closing of the IPO, Microsoft will no longer be a 10% beneficial owner of any class of equity security of Facebook registered under Section 12 of the Securities Exchange Act of 1934, as amended, and, therefore, will no longer be subject to Section 16 of such Act. In addition, Microsoft plans to file a Form 4 following the closing of the IPO which reflects, as of such closing, the automatic conversion of Microsoft's Series D Preferred Stock into shares of Class B Common Stock, Microsoft's subsequent conversion of certain of such shares of Class B Common Stock into shares of Class A Common Stock, and Microsoft's subsequent sale of such shares of Class A Common Stock in connection with the IPO. |
Reporting Owners
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Reporting Owner Name / Address |
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Director | 10% Owner | Officer | Other | ||
MICROSOFT CORP
ONE MICROSOFT WAY REDMOND, WA 98052-6399 |
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X |
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Signatures
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Keith R. Dolliver, Assistant Secretary for Microsoft Corporation | 5/17/2012 | |
** 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. |
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. |