Initial Statement of Beneficial Ownership (3)
June 13 2019 - 4:03PM
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
Estimated average burden
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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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King Timothy P
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2. Date of Event Requiring Statement (MM/DD/YYYY)
6/5/2019
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3. Issuer Name
and
Ticker or Trading Symbol
ALLIANCE DATA SYSTEMS CORP [ADS]
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(Last)
(First)
(Middle)
3075 LOYALTY CIRCLE
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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)
EVP & Chief Financial Officer /
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(Street)
COLUMBUS, OH 43219
(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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11967.752
(1)
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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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Explanation of Responses:
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(1)
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The total number of securities beneficially owned includes: (a) 3,755.752 unrestricted shares; (b) 245 unvested units from an award of 720 time-based restricted stock units granted 2/15/17, which are scheduled to vest on 2/18/20; (c) 684 unvested units from an award of 2,010 performance-based restricted stock units granted 2/15/17, which are scheduled to vest on 2/18/20; (d) 475 unvested units from an award of 708 time-based restricted stock units granted 2/15/18, of which 234 units will vest on 2/18/20 and 241 units will vest on 2/16/21; (e) 1,439 unvested units from an award of 2,147 performance-based restricted stock units granted 2/15/18, of which 709 units will vest on 2/18/20 and 730 units will vest on 2/16/21; (f) 1,073 unvested time-based restricted stock units granted 2/15/19, of which 354 units will vest on each of 2/18/20 and 2/16/21 and 365 units will vest on 2/15/22; (continued below)
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Remarks:
(1) continued from above: and (g) 4,296 unvested performance-based restricted stock units granted 2/15/19, which may be adjusted up or down at the time the performance restriction lapses. The restriction may lapse with respect to 33% of such shares on each of 2/18/20 and 2/16/21 and with respect to 34% of such shares on 2/15/22 contingent on meeting an EBT metric for 2019 and subject to continued employment by the Reporting Person on the vesting dates.
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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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King Timothy P
3075 LOYALTY CIRCLE
COLUMBUS, OH 43219
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EVP & Chief Financial Officer
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Signatures
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Cynthia L. Hageman, Attorney in Fact
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6/13/2019
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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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