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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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 _____ Officer (give title below) _____ Other (specify below) |
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 | 8/16/2012 | S (1) | 1898456 | D | $19.98 (2) | 1529138 | I | By The Founders Fund, LP (3) | ||
Class A Common Stock | 8/16/2012 | S (1) | 2558 | D | $20.69 (4) | 1526580 | I | By The Founders Fund, LP (3) | ||
Class A Common Stock | 8/16/2012 | S (1) | 239791 | D | $19.98 (2) | 501169 | I | By The Founders Fund II, LP (5) | ||
Class A Common Stock | 8/16/2012 | S (1) | 324 | D | $20.69 (4) | 500845 | I | By The Founders Fund II, LP (5) | ||
Class A Common Stock | 8/16/2012 | S (1) | 11858 | D | $19.98 (2) | 24782 | I | By The Founders Fund II Principals Fund, LP (6) | ||
Class A Common Stock | 8/16/2012 | S (1) | 16 | D | $20.69 (4) | 24766 | I | By The Founders Fund II Principals Fund, LP (6) | ||
Class A Common Stock | 8/16/2012 | S (1) | 7248 | D | $19.98 (2) | 15152 | I | By The Founders Fund II Entrepreneurs Fund, LP (7) | ||
Class A Common Stock | 8/16/2012 | S (1) | 11 | D | $20.69 (4) | 15141 | I | By The Founders Fund II Entrepreneurs Fund, LP (7) | ||
Class A Common Stock | 8/16/2012 | S (1) | 10639320 | D | $19.98 (2) | 7942581 | I | By Rivendell One LLC (8) | ||
Class A Common Stock | 8/16/2012 | S (1) | 14341 | D | $20.69 (4) | 7928240 | I | By Rivendell One LLC (8) | ||
Class A Common Stock | 8/16/2012 | S (1) | 185826 | D | $19.98 (2) | 4884464 | I | By Lembas, LLC (9) | ||
Class A Common Stock | 8/16/2012 | S (1) | 251 | D | $20.69 (4) | 4884213 | I | By Lembas, LLC (9) | ||
Class A Common Stock | 8/16/2012 | J (10) | V | 2235135 | D | $0.00 | 2649078 | I | By Lembas, LLC (9) | |
Class A Common Stock | 8/17/2012 | S (1) | 1022699 | D | $19.27 (11) | 503881 | I | By The Founders Fund, LP (3) | ||
Class A Common Stock | 8/17/2012 | S (1) | 9415 | D | $20.06 (12) | 494466 | I | By The Founders Fund, LP (3) | ||
Class A Common Stock | 8/17/2012 | S (1) | 129397 | D | $19.27 (11) | 371448 | I | By The Founders Fund II, LP (5) | ||
Class A Common Stock | 8/17/2012 | S (1) | 968 | D | $20.06 (12) | 370480 | I | By The Founders Fund II, LP (5) | ||
Class A Common Stock | 8/17/2012 | S (1) | 6388 | D | $19.27 (11) | 18378 | I | By The Founders Fund II Principals Fund, LP (6) | ||
Class A Common Stock | 8/17/2012 | S (1) | 58 | D | $20.06 (12) | 18320 | I | By The Founders Fund II Principals Fund, LP (6) | ||
Class A Common Stock | 8/17/2012 | S (1) | 3903 | D | $19.27 (11) | 11238 | I | By The Founders Fund II Entrepreneurs Fund, LP (7) | ||
Class A Common Stock | 8/17/2012 | S (1) | 38 | D | $20.06 (12) | 11200 | I | By The Founders Fund II Entrepreneurs Fund, LP (7) | ||
Class A Common Stock | 8/17/2012 | S (1) | 5731995 | D | $19.27 (11) | 2196245 | I | By Rivendell One LLC (8) | ||
Class A Common Stock | 8/17/2012 | S (1) | 52179 | D | $20.06 (12) | 2144066 | I | By Rivendell One LLC (8) | ||
Class A Common Stock | 8/17/2012 | S (1) | 100118 | D | $19.27 (11) | 2548960 | I | By Lembas, LLC (9) | ||
Class A Common Stock | 8/17/2012 | S (1) | 910 | D | $20.06 (12) | 2548050 | I | By Lembas, LLC (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 |
Reporting Owners
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Reporting Owner Name / Address |
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Director | 10% Owner | Officer | Other | ||
THIEL PETER
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 Peter A. Thiel | 8/20/2012 | |
** 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. |
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. |