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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/09/2019 |
3. Issuer Name and Ticker or Trading Symbol
Uber Technologies, Inc [ UBER ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Common Stock | 26,265,620 | D | |
Common Stock | 4,655,648 | I | Irrevocable Remainder Trust(1) |
Common Stock | 1,485,884 | I | Annuity Trust(2) |
Common Stock | 550,000 | I | Irrevocable Descendants' Trust(3) |
Common Stock | 1,485,884 | I | Spouse's Annuity Trust(4) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Stock Option (Right to Buy) | (5) | 02/26/2024 | Common Stock | 167,640 | $0.3295 | D |
Explanation of Responses: |
1. Shares held by The Graves Irrevocable Remainder Trust u/a/d February 25, 2015 for which Mr. Graves and his wife are trustees. |
2. Shares held by The Ryan Graves 2018 Annuity Trust u/a/d/ 5/21/2018 for which Mr. Graves is trustee. |
3. Shares held by The Graves 2018 Irrevocable Descendants' Trust u/a/d 5/21/2018, of which Mr. Graves and his family are beneficiaries. |
4. Shares held by The Molly Graves 2018 Annuity Trust, for which Mr. Graves's wife is trustee. Mr. Graves disclaims beneficial ownership of these shares, except to the extent of his pecuniary interest therein. |
5. These stock options are currently exercisable. |
Remarks: |
/s/ Keir Gumbs by Power of Attorney for Ryan Graves | 05/09/2019 | |
** 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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |