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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 | ||||||||
Option to Purchase Common Stock | $ 5.16 | (2) | 06/15/2022 | Common Stock | 106,231 | 106,231 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Glasman Zvi C/O FOX FACTORY HOLDING CORP. 915 DISC DRIVE SCOTTS VALLEY, CA 95066 |
CFO and Treasurer |
/s/ Zvi Glasman, by David Haugen as attorney-in-fact | 09/04/2014 | |
**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) | Reflects the forfeiture of an aggregate of 69,675 unvested time-based restricted stock units on September 2, 2014 pursuant to the amendment of a prior Restricted Stock Unit Award Agreement between the Reporting Person and the Company. In connection with the amendment to the prior Restricted Stock Unit Award Agreement, on September 2, 2014, the Company and the Reporting Person entered into a new Restricted Stock Unit Award Agreement, pursuant to which the Company granted the Reporting Person 69,675 performance-based restricted stock units, not reported on this Form 4. These shares will be reflected on subsequent Form 4s if and when the performance criteria are met. Should all the performance-based restricted stock units granted on September 2, 2014 to the Reporting Person vest, the number of shares acquired upon such vesting will equal the number of forfeited shares reported on this Form 4. |
(2) | 50% of the option shares vested on June 15, 2013 and 50% of the option shares vested on June 15, 2014. |