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) 12/01/2018 | 3. Issuer Name and Ticker or Trading Symbol ADT Inc. [ ADT ] | |||||||||||||
| 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 | 96,528(1) | 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 | ||||
| Restricted Stock Units | 01/18/2021 | (2) | Common Stock | 21,686 | (2) | D | |
| Stock Options | 07/23/2018(3) | 01/18/2028 | Common Stock | 66,903 | 14 | D | |
| Stock Options | 01/18/2021(4) | 01/18/2028 | Common Stock | 78,781 | 14 | D | |
| Explanation of Responses: |
| 1. On November 21, 2016, the reporting person was granted Class B units in Prime Security Services TopCo Parent, L.P. (the "November 2016 Award"). On January 23, 2018, shares of ADT Inc. common stock were distributed to the reporting person (the "Distributed Shares") by Prime Security Services TopCo Parent, L.P. in redemption of the November 2016 Award. The Distributed Shares reported fully vested on July 23, 2018. |
| 2. Each restricted stock unit ("RSU") was received as a grant under the ADT Inc. 2018 Omnibus Incentive Plan on January 18, 2018, for no consideration, and represents a contingent right to receive one share of ADT Inc. common stock upon vesting and settlement. The RSUs will "cliff vest" as to 100% of the RSUs on the third anniversary of the date of grant, generally subject to the reporting person's continued employment through such date. |
| 3. On January 18, 2018, the reporting person was granted stock options under the ADT Inc. 2018 Omnibus Incentive Plan, which vested on July 23, 2018. |
| 4. The reporting person was granted stock options on January 18, 2018, under the ADT Inc. 2018 Omnibus Incentive Plan. The stock options will "cliff vest" and become exercisable as to 100% of the stock options on the third anniversary of the date of grant, generally subject to the reporting person's continued employment through such date. |
| Remarks: |
| /s/ Lee Jackson attorney-in-fact | 12/10/2018 | |
| ** 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. | ||