Initial Statement of Beneficial Ownership (3)
September 11 2018 - 5:55PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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0.5
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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
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Suryadevara Dhivya
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2. Date of Event Requiring Statement (MM/DD/YYYY)
9/1/2018
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3. Issuer Name
and
Ticker or Trading Symbol
General Motors Co [GM]
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(Last)
(First)
(Middle)
300 RENAISSANCE CENTER, M/C: 482-C23-A68
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Executive Vice President & CFO /
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(Street)
DETROIT, MI 48207
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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25617
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Restricted Stock Units
(1)
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(2)
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(2)
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Common Stock
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2210.0
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(2)
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D
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Employee Stock Option (Right to Buy)
(3)
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(3)
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2/28/2025
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Common Stock
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113883.0
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$31.32
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D
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Employee Stock Option (Right to Buy)
(4)
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(4)
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6/7/2027
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Common Stock
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36898.0
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$34.34
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D
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Employee Stock Option (Right to Buy)
(5)
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(5)
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2/13/2028
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Common Stock
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22193.0
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$41.4
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D
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Explanation of Responses:
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(1)
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The RSUs were awarded on February 10, 2016 and will vest on February 10, 2019. Each RSU represents a right to receive one share of the Company's Common Stock upon settlement.
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(2)
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The RSUs do not have a conversion or exercise price, or a date on which they are exercisable or expire.
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(3)
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The Stock Options were granted on July 28, 2015. 60% of the options have vested. 20% vest on February 15, 2019 upon GM meeting or exceeding the median Total Shareholder Return ("TSR") of the original equipment manufacturers, other than GM, as of the grant date in the Dow Jones Automobiles and Parts Titan 30 Index ("OEM Peer Group") for the period July 28, 2015 through December 31, 2018; and the remaining 20% will vest on February 15, 2020 upon GM meeting or exceeding the median TSR of the OEM Peer Group for the period July 28, 2015 through December 31, 2019.
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(4)
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The Stock Options were granted on June 7, 2017 and began being settled in three equal, annual installments on February 14, 2018.
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(5)
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The Stock Options were granted on February 13, 2018 and will vest annually in three equal installments beginning February 13, 2019.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Suryadevara Dhivya
300 RENAISSANCE CENTER
M/C: 482-C23-A68
DETROIT, MI 48207
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Executive Vice President & CFO
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Signatures
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/s/ Tia Y. Turk, Attorney-in-Fact for Ms. Suryadevara
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9/11/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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