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 |
|
1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 01/27/2017 | 3. Issuer Name and Ticker or Trading Symbol JELD-WEN Holding, Inc. [ JELD ] | |||||||||||||
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)
|
Table I - Non-Derivative Securities Beneficially Owned | |||
---|---|---|---|
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 | 167,277(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
---|---|---|---|---|---|---|---|
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 | ||||
Common Stock Option (Right to Buy) | (2) | 11/30/2025 | Common Stock | 95,700 | 19.58 | D | |
Class B-1 Stock Option (Right to Buy)(5) | (3) | 11/30/2025 | Common Stock | 409,087(4) | 15.9(4) | D |
Explanation of Responses: |
1. This amount includes 123,750 restricted stock units that will vest in equal installments on November 30, 2017, November 30, 2018 and November 30, 2019. |
2. This option is vested with respect to 19,140 underlying shares and will vest with respect to the remaining 76,560 underlying shares in equal installments on November 30, 2017, November 30, 2018, November 30, 2019 and November 30, 2020. |
3. This option is vested with respect to 81,817 underlying shares and will vest with respect to the remaining 327,270 underlying shares in equal installments on November 30, 2017, November 30, 2018, November 30, 2019 and November 30, 2020. |
4. As of the date of the reporting event, and prior to the Class B-1 Conversion (as defined below), represents Class B-1 Stock Options exercisable for an aggregate of 234,300 shares of Class B-1 Common Stock, each with an exercise price of $27.77. |
5. Immediately prior to the consummation of the initial public offering of the issuer's Common Stock, Class B-1 Stock Options will become exercisable for Common Stock (the "Class B-1 Conversion"). For purposes of this table, the number of options and the applicable exercise prices are presented on a post-Class B-1 Conversion basis. The footnote above indicates the number of Class B-1 Stock Options outstanding and the applicable exercise price with respect to shares of Class B-1 Common Stock as of the date of the reporting event. |
/s/ Laura W. Doerre, Attorney-in-Fact for Mark A. Beck | 01/27/2017 | |
** 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. |