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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 2270 (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 at End of Issuer's Fiscal Year (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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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Boal Steven R. C/O COUPONS.COM INCORPORATED 400 LOGUE AVENUE MOUNTAIN VIEW, CA 94043 |
 X |  |  President & CEO |  |
/s/Richard Hornstein Atty-in-Fact for Steven R. Boal | 01/22/2015 | |
**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) | These shares were previously reported as directly beneficially owned but were contributed on November 4, 2014 to the SMSEJ Family Trust U/A Dated July 18, 2005 of which Mr. Boal is a co-trustee. |
(2) | Represents shares transferred by the Annuity Trust of Mr. Boal. Mr. Boal simultaneously contributed these shares to the SMSEJ Family Trust Trust U/A Dated July 18, 2015 of which Mr. Boal is a co-trustee. |
(3) | Represents shares transferred by the Annuity Trust of Mrs. Boal. Mrs. Boal simultaneously contributed these shares to the SMSEJ Family Trust U/A Dated July 18, 2015 of which Mrs. Boal is a co-trustee. |
(4) | The shares are held directly by Stuart Shiff TTEE of the EBB 2011 Trust dated September 23, 2011 |
(5) | The shares are held directly by Stuart Shiff TTEE of the JMB 2011 Trust dated September 23, 2011. |
(6) | The shares are held directly by Stuart Shiff TTEE of the SEB 2011 Trust dated September 23, 2011. |