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
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1. Name and Address of Reporting Person
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Sandberg Sheryl |
2. Issuer Name
and
Ticker or Trading Symbol
Facebook Inc [ FB ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__ X __ Director _____ 10% Owner __ X __ Officer (give title below) _____ Other (specify below) Chief Operating Officer |
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 |
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 | 1/15/2017 | C | 74940 (1) | A | $0 | 2945900 | D | |||
Class A Common Stock | 1/15/2017 | F | 39104 (2) | D | $128.34 | 2906796 | D | |||
Class A Common Stock | 1/18/2017 | C | 52404 (3) | A | $0 | 2959200 | D | |||
Class A Common Stock | 1/18/2017 | S (4) | 47527 | D | $127.516 (5) | 2911673 | D | |||
Class A Common Stock | 1/18/2017 | S (4) | 4877 | D | $128.0291 (6) | 2906796 | D | |||
Class A Common Stock | 1/18/2017 | S (4) | 47302 | D | $127.4857 (7) | 2859494 | D | |||
Class A Common Stock | 1/18/2017 | S (4) | 9294 | D | $127.9636 (8) | 2850200 | D | |||
Class A Common Stock | 23824 | I | By Sheryl K. Sandberg, Trustee of the Sandberg-Goldberg Family Trust Dated September 3, 2004 (9) |
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 | ||||||||
Restricted Stock Unit (RSU) (Class B) | (10) | 1/15/2017 | M | 74940 | (11) | 3/24/2021 | Class B Common Stock (12) | 74940 | $0 | 224821 | D | ||||
Class B Common Stock (12) | (12) | 1/15/2017 | M | 74940 | (12) | (12) | Class A Common Stock | 74940 | $0 | 74940 | D | ||||
Class B Common Stock (12) | (12) | 1/15/2017 | C | 74940 (13) | (12) | (12) | Class A Common Stock | 74940 | $0 | 0 | D | ||||
Stock Option (Right to Buy Class B Common Stock) | $10.388 | 1/18/2017 | M | 52404 | (14) | 7/22/2020 | Class B Common Stock (12) | 52404 | $0 | 1980284 | D | ||||
Class B Common Stock (12) | (12) | 1/18/2017 | M | 52404 | (12) | (12) | Class A Common Stock | 52404 | $0 | 52404 | D | ||||
Class B Common Stock (12) | (12) | 1/18/2017 | C | 52404 (13) | (12) | (12) | Class A Common Stock | 52404 | $0 | 0 | D |
Reporting Owners
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Reporting Owner Name / Address |
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Director | 10% Owner | Officer | Other | ||
Sandberg Sheryl
C/O FACEBOOK, INC. 1601 WILLOW ROAD MENLO PARK, CA 94025 |
X |
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Chief Operating Officer |
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Signatures
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/s/ Michael Johnson as attorney-in-fact for Sheryl K. Sandberg | 1/18/2017 | |
** 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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