SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 01/15/2016 | 3. Issuer Name and Ticker or Trading Symbol GCP Applied Technologies Inc. [ GCP ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock, par value $0.01 per share | 100(1)(2) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. This Form 3 is being filed in connection with the U.S. SEC's declaration of effectiveness of the Registration Statement on Form 10 of GCP Applied Technologies Inc. ("GCP"), which describes the planned separation of GCP from W. R. Grace & Co. ("Grace"). The 100 shares of GCP's Common Stock reported hereunder are held of record by a direct wholly owned subsidiary of Grace. |
2. Pursuant to an amendment to GCP's Certificate of Incorporation to become effective prior to said separation, effective as of the close of business on the date set by resolution of the Board of Directors of Grace as the record date for distribution of shares of GCP's Common Stock to holders of shares of Grace's common stock (such time, the "Effective Time"), the 100 shares of GCP's Common Stock shall, automatically by operation of law and without any further action of the part of GCP, Grace or said subsidiary, be subdivided and converted into a number of shares of validly issued, fully paid and non-assessable shares of GCP's Common Stock equal to the number of shares of common stock, par value $0.01 per share, of Grace, issued and outstanding as of the Effective Time. |
Remarks: |
/s/ Mark A. Shelnitz | 01/15/2016 | |
** Signature of Reporting Person | Date | |
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 5 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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. |