0001127602-15-024513.txt : 20150807
0001127602-15-024513.hdr.sgml : 20150807
20150807183141
ACCESSION NUMBER: 0001127602-15-024513
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150805
FILED AS OF DATE: 20150807
DATE AS OF CHANGE: 20150807
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: 151038814
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
2015-08-05
0001326801
Facebook Inc
FB
0001621141
Koum Jan
C/O FACEBOOK, INC.
1601 WILLOW ROAD
MENLO PARK
CA
94025
1
Class A Common Stock
2015-08-05
5
G
0
E
3500000
0
D
54313738
I
By Jan Koum, Trustee of The Butterfly Trust U/A/D 1/20/2004
Class A Common Stock
2015-08-05
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 VI U/A/D 8/5/2015
Class A Common Stock
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
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
141489
I
By Jan Koum, Trustee of The Jan Koum Trust II U/A/D 8/5/2014
Class A Common Stock
3817873
I
By Jan Koum, Trustee of The Jan Koum Trust III U/A/D 10/9/2014
On August 5, 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 VI U/A/D 8/5/2015, 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 VI U/A/D 8/5/2015
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.
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 II U/A/D 8/5/2014.
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
2015-08-07