Washington Form 5 PDF Details

The Washington 5 form plays a crucial role in maintaining transparency and accountability within the United States securities market. Regulated by the Securities and Exchange Commission (SEC), this form acts as an annual statement of changes in beneficial ownership of securities. Those who fall under its purview include directors, officers, and owners holding more than 10% of a company's stock, clarifying their transactions and holdings over the fiscal year. It is a procedural requirement that ensures any person filling out the form submits it electronically via a specified platform, highlighting the SEC’s stride towards modernizing its filing processes. The mentioning of an OMB control number emphasizes the form's legitimacy and compliance with broader governmental requirements. Moreover, by delineating direct and indirect securities, including derivatives like puts, calls, and options, the form provides a comprehensive picture of one's investment movements. Its structure encourages transparency, aiding in the prevention of fraud and conflict of interest in the corporate sphere. The document stipulates severe repercussions for intentional misinformation, underscoring the form's importance in upholding the integrity of financial reporting and market operations.

QuestionAnswer
Form NameWashington Form 5
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform5 form 5 for sec

Form Preview Example

Potential persons who are to respond to the collection of informa­ tion contained in this form are not required to respond unless the form displays a currently valid OMB control number.

You may not send a completed printout of this form to the SEC to satisfy a filing obligation. submitting the information required by this form to the SEC in electronic format online at

You can only satisfy an SEC filing obligation by https://www.onlineforms.edgarfiling.sec.gov.

FORM 5

Check box if no longer subject to Section 16. Form 4 or Form 5 obli- gations may continue. SEE Instruc- tion 1(b).

Form 3 Holdings Reported Form 4 Transactions Reported

UNITEDSTATESSECURITIESANDEXCHANGECOMMISSION

Washington,D.C.20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF

SECURITIES

OMB APPROVAL

OMB Number:

3235­0362

Expires:

January 31,2014

Estimated average burden

hours per response. . . . . . . 1.0

1.

Name and Address of Reporting Person*

 

 

2.

Issuer Name and Ticker or Trading Symbol

 

 

5. Relationship of Reporting Person(s) to Issuer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Check all applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____ Director

_____ 10% Owner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____ Officer (give

_____ Other (specify

 

(Last)

(First)

 

(Middle)

3.

Statement for Issuer's Fiscal

4. If Amendment, Date

 

 

 

title

 

below)

 

 

 

 

 

 

Year Ended

 

 

 

OriginalFiled

 

 

 

below)

 

 

 

 

 

 

 

 

 

(Month//Day/Year)

 

 

(Month/Day/Year)

 

____________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. Individual or Joint/Group Reporting

 

 

 

(Street)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(check applicable line)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____ Form Filed by One Reporting Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____ Form Filed by More than One Reporting Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City)

(State)

(Zip)

 

 

 

 

Table I — Non­Derivative Securities Acquired, Disposed of, or Beneficially Owned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

Title of Security

 

 

2. Trans­

2A.Deemed

3.

Trans­

 

4. Securities Acquired (A) or

 

 

 

5. Amount of

6. Owner­

7.

Nature of

 

(Instr. 3)

 

 

action

 

Execu­

 

action

 

Disposed of (D)

 

 

 

 

 

Securities Ben­

ship

 

Indirect

 

 

 

 

Date

 

tion

 

Code

 

(Instr. 3, 4 and 5)

 

 

 

eficially Owned

Form: Di­

 

Beneficial

 

 

 

 

(Month/

 

Date,

 

(Instr. 8)

 

 

 

 

 

 

at end of

rect (D)

 

Ownership

 

 

 

 

Day/

 

if any

 

 

 

 

 

 

 

 

 

 

 

Issuer’s Fiscal

or Indi­

 

(Instr. 4)

 

 

 

 

Year)

(Month/

 

 

 

 

 

 

(A) or

 

 

 

 

Year

rect (I)

 

 

 

 

 

 

 

 

Day/

 

 

 

 

 

 

 

 

 

 

(Instr. 3 and 4)

(Instr. 4)

 

 

 

 

 

 

 

 

 

 

 

Amount

 

(D)

 

Price

 

 

 

 

 

 

 

 

 

 

Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see instruction 4(b)(v).

(Over) SEC2270(11­11)

FORM 5 (continued)

Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned

 

(E.G., puts, calls, warrants, options, convertible securities)

1. Title of Derivative

2.

Conver-

3. Trans-

Security

 

sion or

action

(Instr. 3)

 

Exer-

Date

 

 

cise

(Month/

 

 

Price of

Day/

 

 

Deriva-

Year)

 

 

tive Se-

 

 

 

curity

 

 

 

 

 

 

 

 

 

3A.Deemed

4. Transac-

5.

Number of Deriva-

6.

Date Exercis-

7.

Title and Amount of Underly-

8. Price

9.

Number

10. Owner-

11. Nature of

Execetion

tion

 

tive Securities Ac-

 

able and Expi-

 

ing Securities

 

of

 

of De-

ship

Indirect

Date, if

Code

 

quired (A) or Dis-

 

ration Date

 

(Instr. 3 and 4)

 

De-

 

rivative

Form

Benefi-

any

(Instr. 8)

 

posed of (D)

 

(Month/Day/

 

 

 

riva-

 

Securi-

of De-

cial

(Month/

 

 

(Instr. 3, 4, and 5)

 

Year)

 

 

 

 

tive

 

ties Ben-

rivative

Owner-

Day/

 

 

 

 

 

 

 

 

 

 

 

Secu-

 

eficially

Securi-

ship

Year)

 

 

 

 

 

 

 

 

 

 

 

rity

 

Owned

ties:

(Instr. 4)

 

 

 

 

 

 

 

 

 

 

 

 

(Instr. 5)

 

at End of

Direct

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issuer's

(D) or

 

 

 

 

 

 

Date

 

Expira-

 

 

Amount or

 

 

Fiscal

Indirect

 

 

 

 

 

 

 

 

 

 

 

Year

(I)

 

 

 

 

 

 

Exer-

 

tion

 

 

Number of

 

 

 

 

 

 

 

 

 

 

 

 

 

(Instr.

(Instr. 4)

 

 

 

 

 

 

cisable

 

Date

 

Title

Shares

 

 

 

 

 

 

 

 

 

 

 

 

4)

 

 

 

 

 

(A)

(D)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explanation of Responses:

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations.

** Signature of Reporting Person

Date

SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

 

 

Note: File three copies of this Form, one of which must be manually signed.

 

 

If space provided is insufficient, SEE Instruction 6 for procedure.

 

 

Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.

Page 2

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