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)
_____ 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)
___ Form filed by One Reporting Person _ X _ 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 | J (1) | V | 49698765 | D | $0.00 | 56612648 | I | By Accel IX L.P. (2) | |
Class A Common Stock | 8/16/2012 | J (1) | V | 5294863 | D | $0.00 | 6032562 | I | By Accel IX Strategic Partners L.P. (3) | |
Class A Common Stock | 8/16/2012 | C | 2785949 | A | $0.00 | 2785949 | I | By Accel Growth Fund L.P. (4) | ||
Class A Common Stock | 8/16/2012 | J (1) | V | 2785949 | D | $0.00 | 0 | I | By Accel Growth Fund L.P. (4) | |
Class A Common Stock | 8/16/2012 | C | 54385 | A | $0.00 | 54385 | I | By Accel Growth Fund Strategic Partners L.P. (5) | ||
Class A Common Stock | 8/16/2012 | J (1) | V | 54385 | D | $0.00 | 0 | I | By Accel Growth Fund Strategic Partners L.P. (5) | |
Class A Common Stock | 8/16/2012 | J (1) | V | 724144 | A | $0.00 | 724144 | I | By Accel Growth Fund Associates L.L.C. (6) | |
Class A Common Stock | 8/16/2012 | J (1) | V | 16491451 | A | $0.00 | 16491451 | I | By Accel IX Associates L.L.C. (7) | |
Class A Common Stock | 8/16/2012 | J (8) | 176416 | A | $0.00 | 176416 | I | By Accel Meritech Associates III L.L.C. (9) | ||
Class A Common Stock | 8/16/2012 | J (8) | 98018 | A | $0.00 | 98018 | I | By Accel Meritech Investors III L.L.C. (10) | ||
Class A Common Stock | 9910536 | I | By Accel Investors 2005 L.L.C. (11) |
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 | ||||||||
Class B Common Stock (12) | (12) | 8/16/2012 | C | 2785949 | (12) | (12) | Class A Common Stock (13) | 2785949 | $0.00 | 4741307 | I | By Accel Growth Fund L.P. (4) | |||
Class B Common Stock (12) | (12) | 8/16/2012 | C | 54385 | (12) | (12) | Class A Common Stock (13) | 54385 | $0.00 | 92554 | I | By Accel Growth Fund Strategic Partners L.P. (5) | |||
Class B Common Stock (12) | (12) | (12) | (12) | Class A Common Stock | 100292 | 100292 | I | By Accel Growth Fund Investors 2009 L.L.C. (14) |
Remarks:
In prior filings for the issuer, certain individual managing members of Accel IX Associates L.L.C., Accel Growth Fund Associates L.L.C., Accel Investors 2005 L.L.C. and Accel Growth Fund Investors 2009 L.L.C. were included as reporting persons. These individuals are not beneficial owners of shares amounting to 10% or more of the issuer and are therefore not required to report on this or future filings. |
Signatures
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel IX Associates L.L.C., the General Partner of Accel IX L.P. | 8/20/2012 | |
** Signature of Reporting Person |
Date
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel Growth Fund Associates L.L.C. | 8/20/2012 | |
** Signature of Reporting Person |
Date
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel Growth Fund Investors 2009 L.L.C. | 8/20/2012 | |
** Signature of Reporting Person |
Date
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel Growth Fund Associates L.L.C., the General Partner of Accel Growth Fund L.P. | 8/20/2012 | |
** Signature of Reporting Person |
Date
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel Growth Fund Associates L.L.C., the General Partner of Accel Growth Fund Strategic Partners L.P. | 8/20/2012 | |
** Signature of Reporting Person |
Date
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel Investors 2005 L.L.C. | 8/20/2012 | |
** Signature of Reporting Person |
Date
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel IX Associates L.L.C. | 8/20/2012 | |
** Signature of Reporting Person |
Date
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel IX Associates L.L.C., the General Partner of Accel IX Strategic Partners L.P. | 8/20/2012 | |
** Signature of Reporting Person |
Date
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel Meritech Associates III L.L.C. | 8/20/2012 | |
** Signature of Reporting Person |
Date
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Tracy L. Sedlock as attorney-in-fact for James W. Breyer as a Managing Member of Accel Meritech Investors III L.L.C. | 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. |
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