SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Peterson Jason D.

(Last) (First) (Middle)
41 UNIVERSITY DRIVE SUITE 202

(Street)
NEWTOWN PA 18940

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/10/2017
3. Issuer Name and Ticker or Trading Symbol
EPAM Systems, Inc. [ EPAM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Financial Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
EPAM Common Stock 8,733(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) (2) 04/05/2027 EPAM Common Stock 25,432 $74.44 D
Explanation of Responses:
1. Represents (a) an award of 4,031 restricted stock units that are scheduled to vest as to 25% of the shares on each of April 5, 2018, 2019, 2020 and 2021; and (b) an award of 4,702 restricted stock units that are scheduled to vest as to 25% of the shares on each of April 5, 2018, 2019, 2020 and 2021; in each case subject to the terms of the Issuer's 2015 Long Term Incentive Plan and the applicable award agreement.
2. Options representing the right to purchase a total of 25,432 shares, will become exercisable as to 25% of the underlying shares on each of April 5, 2018, 2019, 2020 and 2021.
Remarks:
/s/ Ginger Mosier, as Attorney-in-Fact 05/10/2017
** 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.
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