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