SEC Form 4[TABLE="width: 100%"]
[TR]
[TD="colspan: 2, align: center"]FORM 4[/TD]
[TD="align: center"]UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940[/TD]
[TD="align: center"][TABLE="width: 100%"]
[TR]
[TD]OMB APPROVAL[/TD]
[/TR]
[TR]
[TD][TABLE="width: 100%"]
[TR]
[TD="colspan: 3"]OMB Number:[/TD]
[TD]3235-0287[/TD]
[/TR]
[TR]
[TD]Expires:[/TD]
[TD="colspan: 3"]December 31, 2014[/TD]
[/TR]
[TR]
[TD="colspan: 4"]Estimated average burden[/TD]
[/TR]
[TR]
[TD="colspan: 3"]hours per response:[/TD]
[TD]0.5[/TD]
[/TR]
[/TABLE]
[/TD]
[/TR]
[/TABLE]
[/TD]
[/TR]
[TR]
[TD][TABLE="width: 100%"]
[TR]
[TD][/TD]
[/TR]
[/TABLE]
[/TD]
[TD]Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD]1. Name and Address of Reporting Person[SUP]*[/SUP][TABLE="width: 100%"]
[TR]
[TD]Zuckerberg Mark[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD](Last)[/TD]
[TD](First)[/TD]
[TD](Middle)[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD]C/O FACEBOOK, INC.[/TD]
[/TR]
[TR]
[TD]1601 WILLOW ROAD[/TD]
[/TR]
[/TABLE]
(Street)[TABLE="width: 100%"]
[TR]
[TD]MENLO PARK[/TD]
[TD]CA[/TD]
[TD]94025[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD](City)[/TD]
[TD](State)[/TD]
[TD](Zip)[/TD]
[/TR]
[/TABLE]
[/TD]
[TD]2. Issuer Name and Ticker or Trading Symbol
Facebook Inc [ FB ][/TD]
[TD]5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)[TABLE="width: 100%"]
[TR]
[TD="align: center"]X[/TD]
[TD]Director[/TD]
[TD="align: center"]X[/TD]
[TD]10% Owner[/TD]
[/TR]
[TR]
[TD="align: center"]X[/TD]
[TD]Officer (give title below)[/TD]
[TD="align: center"][/TD]
[TD]Other (specify below)[/TD]
[/TR]
[TR]
[TD="colspan: 4, align: center"]COB and CEO[/TD]
[/TR]
[/TABLE]
[/TD]
[/TR]
[TR]
[TD]3. Date of Earliest Transaction (Month/Day/Year)
05/22/2012[/TD]
[/TR]
[TR]
[TD]4. If Amendment, Date of Original Filed (Month/Day/Year)[/TD]
[TD]6. Individual or Joint/Group Filing (Check Applicable Line)[TABLE="width: 100%"]
[TR]
[TD="align: center"]X[/TD]
[TD]Form filed by One Reporting Person[/TD]
[/TR]
[TR]
[TD="align: center"][/TD]
[TD]Form filed by More than One Reporting Person[/TD]
[/TR]
[/TABLE]
[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TH="colspan: 11, align: center"]Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned[/TH]
[/TR]
[TR]
[TH="align: left"]1. Title of Security (Instr. 3)[/TH]
[TH="align: left"]2. Transaction Date (Month/Day/Year)[/TH]
[TH="align: left"]2A. Deemed Execution Date, if any (Month/Day/Year)[/TH]
[TH="colspan: 2, align: left"]3. Transaction Code (Instr. 8)[/TH]
[TH="colspan: 3, align: left"]4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)[/TH]
[TH="align: left"]5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)[/TH]
[TH="align: left"]6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)[/TH]
[TH="align: left"]7. Nature of Indirect Beneficial Ownership (Instr. 4)[/TH]
[/TR]
[TR]
[TH="align: center"]Code[/TH]
[TH="align: center"]V[/TH]
[TH="align: center"]Amount[/TH]
[TH="align: center"](A) or (D)[/TH]
[TH="align: center"]Price[/TH]
[/TR]
[TR]
[TD="align: left"]Class A Common Stock[/TD]
[TD="align: center"]05/22/2012[/TD]
[TD="align: center"][/TD]
[TD="align: center"]C[/TD]
[TD="align: center"][/TD]
[TD="align: center"]30,200,000[/TD]
[TD="align: center"]A[/TD]
[TD="align: center"]$0.00[/TD]
[TD="align: center"]30,200,000[/TD]
[TD="align: center"]D[/TD]
[TD="align: left"][/TD]
[/TR]
[TR]
[TD="align: left"]Class A Common Stock[/TD]
[TD="align: center"]05/22/2012[/TD]
[TD="align: center"][/TD]
[TD="align: center"]S[/TD]
[TD="align: center"][/TD]
[TD="align: center"]30,200,000[/TD]
[TD="align: center"]D[/TD]
[TD="align: center"]$37.58[/TD]
[TD="align: center"]0[/TD]
[TD="align: center"]D[/TD]
[TD="align: left"][/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TH="colspan: 16, align: center"]Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)[/TH]
[/TR]
[TR]
[TH="align: left"]1. Title of Derivative Security (Instr. 3)[/TH]
[TH="align: left"]2. Conversion or Exercise Price of Derivative Security[/TH]
[TH="align: left"]3. Transaction Date (Month/Day/Year)[/TH]
[TH="align: left"]3A. Deemed Execution Date, if any (Month/Day/Year)[/TH]
[TH="colspan: 2, align: left"]4. Transaction Code (Instr. 8)[/TH]
[TH="colspan: 2, align: left"]5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)[/TH]
[TH="colspan: 2, align: left"]6. Date Exercisable and Expiration Date (Month/Day/Year)[/TH]
[TH="colspan: 2, align: left"]7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)[/TH]
[TH="align: left"]8. Price of Derivative Security (Instr. 5)[/TH]
[TH="align: left"]9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)[/TH]
[TH="align: left"]10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)[/TH]
[TH="align: left"]11. Nature of Indirect Beneficial Ownership (Instr. 4)[/TH]
[/TR]
[TR]
[TH="align: center"]Code[/TH]
[TH="align: center"]V[/TH]
[TH="align: center"](A)[/TH]
[TH="align: center"](D)[/TH]
[TH="align: center"]Date Exercisable[/TH]
[TH="align: center"]Expiration Date[/TH]
[TH="align: center"]Title[/TH]
[TH="align: center"]Amount or Number of Shares[/TH]
[/TR]
[TR]
[TD="align: left"]Class B Common Stock [SUP](1)[/SUP][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"]05/22/2012[/TD]
[TD="align: center"][/TD]
[TD="align: center"]C[/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"]30,200,000[/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"]Class A Common Stock [SUP](2)[/SUP][/TD]
[TD="align: center"]30,200,000[/TD]
[TD="align: center"]$0.00[/TD]
[TD="align: center"]30,432,762[/TD]
[TD="align: center"]D[/TD]
[TD="align: left"][/TD]
[/TR]
[TR]
[TD="align: left"]Class B Common Stock [SUP](1)[/SUP][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"]Class A Common Stock[/TD]
[TD="align: center"]3,416,823[/TD]
[TD="align: center"][/TD]
[TD="align: center"]3,416,823[/TD]
[TD="align: center"]I[/TD]
[TD="align: left"]By Mark Zuckerberg, Trustee of The Mark Zuckerberg 2008 Annuity Trust dated March 13, 2008 [SUP](3)[/SUP][/TD]
[/TR]
[TR]
[TD="align: left"]Class B Common Stock [SUP](1)[/SUP][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"]Class A Common Stock[/TD]
[TD="align: center"]409,752,262[/TD]
[TD="align: center"][/TD]
[TD="align: center"]409,752,262[/TD]
[TD="align: center"]I[/TD]
[TD="align: left"]By Mark Zuckerberg, Trustee of The Mark Zuckerberg Trust dated July 7, 2006 [SUP](4)[/SUP][/TD]
[/TR]
[TR]
[TD="align: left"]Class B Common Stock [SUP](1)[/SUP][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"][SUP](1)[/SUP][/TD]
[TD="align: center"]Class A Common Stock[/TD]
[TD="align: center"]3[/TD]
[TD="align: center"][/TD]
[TD="align: center"]3[/TD]
[TD="align: center"]I[/TD]
[TD="align: left"]By Mark Zuckerberg, Trustee of the Openess Trust, dated April 12, 2012 [SUP](5)[/SUP][/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD]Explanation of Responses:[/TD]
[/TR]
[TR]
[TD]1. The Class B Common Stock is convertible into the issuer's Class A Common Stock on a 1-for-1 basis (a) at the holder's option or (b) upon certain transfers of such shares and has no expiration date.[/TD]
[/TR]
[TR]
[TD]2. The shares of Class B Common Stock automatically converted into Class A Common Stock on a 1-for-1 basis in connection with the transfer of such shares.[/TD]
[/TR]
[TR]
[TD]3. Shares held of record by Mark Zuckerberg, Trustee of The Mark Zuckerberg 2008 Annuity Trust dated March 13, 2008.[/TD]
[/TR]
[TR]
[TD]4. Shares held of record by Mark Zuckerberg, Trustee of The Mark Zuckerberg Trust dated July 7, 2006.[/TD]
[/TR]
[TR]
[TD]5. Shares held of record by Mark Zuckerberg, Trustee of the Openess Trust dated April 12, 2012.[/TD]
[/TR]
[TR]
[TD]Remarks:[/TD]
[/TR]
[TR]
[TD][/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD][/TD]
[TD]/s/ Michael Johnson as attorney-in-fact for Mark Zuckerberg[/TD]
[TD]05/22/2012[/TD]
[/TR]
[TR]
[TD][/TD]
[TD]** Signature of Reporting Person[/TD]
[TD]Date[/TD]
[/TR]
[TR]
[TD="colspan: 3"]Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.[/TD]
[/TR]
[TR]
[TD="colspan: 3"]* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).[/TD]
[/TR]
[TR]
[TD="colspan: 3"]** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).[/TD]
[/TR]
[TR]
[TD="colspan: 3"]Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.[/TD]
[/TR]
[TR]
[TD="colspan: 3"]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 Number.[/TD]
[/TR]
[/TABLE]
http://www.sec.gov/Archives/edgar/data/1326801/000120919112029812/xslF345X03/doc4.xml
