0001127602-15-015883.txt : 20150501
0001127602-15-015883.hdr.sgml : 20150501
20150501200924
ACCESSION NUMBER: 0001127602-15-015883
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150429
FILED AS OF DATE: 20150501
DATE AS OF CHANGE: 20150501
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Facebook Inc
CENTRAL INDEX KEY: 0001326801
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING, DATA PROCESSING, ETC. [7370]
IRS NUMBER: 201665019
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1601 WILLOW ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-618-7714
MAIL ADDRESS:
STREET 1: 1601 WILLOW ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Koum Jan
CENTRAL INDEX KEY: 0001621141
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35551
FILM NUMBER: 15826070
MAIL ADDRESS:
STREET 1: C/O FACEBOOK, INC.
STREET 2: 1601 WILLOW ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
form4.xml
PRIMARY DOCUMENT
X0306
4
2015-04-29
0001326801
Facebook Inc
FB
0001621141
Koum Jan
C/O FACEBOOK, INC.
1601 WILLOW ROAD
MENLO PARK
CA
94025
1
Class A Common Stock
2015-02-11
5
G
0
E
3442873
0
D
57637354
I
By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004
Class A Common Stock
2015-02-11
5
G
0
E
3442873
0
A
3442873
I
By Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust IV U/A/D 2/4/2015
Class A Common Stock
2015-04-29
4
J
0
3676384
80.455
D
141489
I
By Jan Koum, Trustee of The Jan Koum Trust II U/A/D 8/5/2014
Class A Common Stock
2015-04-29
4
J
0
3676384
80.455
A
61313738
I
By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004
Class A Common Stock
2015-04-29
5
G
0
E
3500000
0
D
57813738
I
By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004
Class A Common Stock
2015-04-29
5
G
0
E
3500000
0
A
3500000
I
By Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust V U/A/D 4/29/2015
Class A Common Stock
141489
I
By Jan Koum, Trustee of The Jan Koum Trust I U/A/D 4/29/2014
Class A Common Stock
3817873
I
By Jan Koum, Trustee of The Jan Koum Trust III U/A/D 10/9/2014
On February 11, 2015, Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004 contributed 3,442,873 shares of Class A common stock to Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust IV U/A/D 2/4/2015, a grantor retained annuity trust for the benefit of the reporting holder.
Shares held of record by Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004.
Shares held of record by Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust IV U/A/D 2/4/2015.
Represents the transfer of shares from Jan Koum, Trustee of The Jan Koum Trust II U/A/D 8/5/2014 to Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004. This transaction represents a substitution of assets between the trusts, and the reporting person remains the beneficial owner of all of the shares after the transfer.
Shares held of record by Jan Koum, Trustee of The Jan Koum Trust II U/A/D 8/5/2014.
On April 29, 2015, Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004 contributed 3,500,000 shares of Class A common stock to Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust V U/A/D 4/29/2015, a grantor retained annuity trust for the benefit of the reporting holder.
Shares held of record by Jan Koum and BNY Mellon Trust of Delaware, Co-Trustees of The Jan Koum Trust V U/A/D 4/29/2015.
Shares held of record by Jan Koum, Trustee of The Jan Koum Trust I U/A/D 4/29/2014.
Shares held of record by Jan Koum, Trustee of The Jan Koum Trust III U/A/D 10/9/2014.
/s/ Michael Johnson as attorney-in-fact for Jan Koum
2015-05-01