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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
CHAMBERS JOHN T 170 WEST TASMAN DRIVE SAN JOSE, CA 95134 |
X | Chairman and CEO |
/s/ John T. Chambers by Evan Sloves, Attorney-in-Fact | 09/13/2011 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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). |
(1) | Includes 318,255 shares that were previously reported as indirectly beneficially owned by the Chambers Grantor Retained Annuity Trust Number Four (Chambers GRAT #4), which were distributed and became directly owned by the reporting person on November 30, 2010, pursuant to the terms of that trust which provide for annual annuity distributions from that trust to its grantor. Also includes 165,515 shares that were previously reported as indirectly beneficially owned by the Chambers 2013 GRAT #1, 102,144 shares that were previously reported as indirectly beneficially owned by the Chambers 2015 GRAT #1 and 75,036 shares that were previously reported as indirectly beneficially owned by the Chambers 2017 GRAT #1, all of which were distributed and became directly owned by the reporting person on May 25, 2011, pursuant to the terms of each trust which provide for annual annuity distributions from each trust to its grantor. |
(2) | Represents shares withheld for payment of tax liability arising as a result of the partial settlement of four (4) restricted stock unit awards originally reported by the reporting person in Forms 4 filed with the Commission on September 12, 2008, November 16, 2009 and September 17, 2010. |
(3) | These shares were previously reported as directly beneficially owned but were contributed to the Chambers 2012 GRAT on December 22, 2010. |