0001387131-17-000533.txt : 20170203 0001387131-17-000533.hdr.sgml : 20170203 20170203202828 ACCESSION NUMBER: 0001387131-17-000533 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161231 FILED AS OF DATE: 20170203 DATE AS OF CHANGE: 20170203 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FS Investment Corp III CENTRAL INDEX KEY: 0001579412 IRS NUMBER: 900994912 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 201 ROUSE BOULEVARD CITY: PHILADELPHIA STATE: PA ZIP: 19112 BUSINESS PHONE: 215-495-1150 MAIL ADDRESS: STREET 1: 201 ROUSE BOULEVARD CITY: PHILADELPHIA STATE: PA ZIP: 19112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Forman Michael C. CENTRAL INDEX KEY: 0001438253 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 814-01047 FILM NUMBER: 17573842 MAIL ADDRESS: STREET 1: CIRA CENTRE STREET 2: 2929 ARCH STREET, SUITE 675 CITY: PHILADELPHIA STATE: PA ZIP: 19104-2867 5 1 forman-form5_123116.xml OWNERSHIP DOCUMENT X0306 5 2016-12-31 0 0 0 0001579412 FS Investment Corp III NONE 0001438253 Forman Michael C. C/O FS INVESTMENT CORPORATION III 201 ROUSE BOULEVARD PHILADELPHIA PA 19130 1 1 0 0 President and CEO Common Stock 2016-12-23 5 G 0 11111.111 0 D 0 D Common Stock 69230.566 I By The 2011 Forman Investment Trust Bona fide gift by the Reporting Person to a gift to a charitable foundation created by the Reporting Person for no consideration. These shares are directly owned by The 2011 Forman Investment Trust, a trust created by Mr. Forman for the benefit of his minor children. Mr. Forman disclaims beneficial ownership of any shares held by The 2011 Forman Investment Trust that exceed his pecuniary interest therein. Includes shares received on account of reinvested distributions. /s/ Stephen S. Sypherd, Attorney-in-Fact 2017-02-03