SEC FORM
4
SEC Form 4
FORM 4 |
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
|
OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
|
|
|
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
FARO TECHNOLOGIES INC
[ FARO ]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
X |
10% Owner |
X |
Officer (give title below) |
|
Other (specify below) |
President and CEO |
|
3. Date of Earliest Transaction
(Month/Day/Year) 06/30/2004
|
4. If Amendment, Date of Original Filed
(Month/Day/Year)
|
6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
|
Form filed by More than One Reporting Person |
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
|
2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
|
4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
|
5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
|
6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
|
7. Nature of Indirect Beneficial Ownership (Instr.
4)
|
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock, par value $.001 |
|
|
|
|
|
|
|
2,084,108 |
I |
Note 1
|
Common Stock, par value $.001 |
|
|
|
|
|
|
|
102,000 |
I |
Note 2
|
Common Stock, par value $.001 |
|
|
|
|
|
|
|
169,721 |
D |
|
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
|
1. Title of Derivative Security (Instr.
3)
|
2. Conversion or Exercise Price of Derivative Security
|
3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
|
5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
|
6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
|
8. Price of Derivative Security (Instr.
5)
|
9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
|
10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
|
11. Nature of Indirect Beneficial Ownership (Instr.
4)
|
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Contract
|
|
06/30/2004 |
07/01/2004 |
J
|
|
250,000 |
|
|
03/30/2005 |
Common Stock |
250,000 |
|
250,000 |
I |
See Note 7
|
Contract
|
|
06/30/2004 |
07/01/2004 |
J
|
|
250,000 |
|
|
11/30/2005 |
Common Stock |
250,000 |
|
250,000 |
I |
See Note 7
|
Contract
|
|
06/30/2004 |
07/01/2004 |
J
|
|
250,000 |
|
|
03/30/2006 |
Common Stock |
250,000 |
|
250,000 |
I |
See Note 7
|
Explanation of Responses: |
|
/s/ Martin A. Traber, Attorney-in-fact for Simon Raab |
07/06/2004 |
|
** 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
4
(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. |
Exhibit 99
----------
1. The transactions reported on this Form 4 were effected pursuant to Rule
10b5-1 trading plan adopted by reporting person on June 10, 2004.
2. On June 10, 2004, the Reporting Person entered into a Prepaid Forward
Agreement (the "Forward Agreement") relating to the forward sale of up
to 750,000 shares of common stock in three tranches. On June 30, 2004,
the counterparty to the Forward Agreement sold 750,000 shares of common
stock into the public market in accordance with paragraphs (f) and (g)
of Rule 144 under the Securities Act of 1933, as amended, at a
weighted-average per share price equal to $25.8978 (the "Floor Price").
The terms of the first tranche provide that three business days after
March 30, 2005 (the "Maturity Date"), the Reporting Person will deliver
to the counterparty to the Forward Agreement a number of shares of
common stock (or, at the election of the Reporting Person, the cash
equivalent of such shares) based on the following:
(a) if the price per share of common stock, determined in
accordance with the terms of the tranche, for the Maturity
Date (the"Final Price") is equal to or less than the Floor
Price, the Reporting Person will deliver 250,000 shares;
(b) if the Final Price is greater than the Floor Price but less
than $35.00 (the "Cap Price"), the Reporting Person will
deliver a number of shares equal to Floor Price/Final Price x
250,000;
(c) if the Final Price is equal to or greater than the Cap Price,
the Reporting Person will deliver a number of shares equal to
the product of (i) 250,000 x (ii) the sum of (Floor
Price/Final Price) + (Final Price-Cap Price/Final Price).
In consideration of the first tranche of the Forward Agreement, the
Reporting Person received $5,612,053.26.
3. On June 10, 2004, the Reporting Person entered into a Prepaid Forward
Agreement (the "Forward Agreement") relating to the forward sale of up
to 750,000 shares of common stock in three tranches. On June 30,
2004, the counterparty to the Forward Agreement sold 750,000 shares of
common stock into the public market in accordance with paragraphs (f)
and (g) of Rule 144 under the Securities Act of 1933, as amended, at a
weighted-average per share price equal to $25.8978 (the "Floor Price").
The terms of the second tranche provide that three business days after
November 30, 2005 (the "Maturity Date"), the Reporting Person will
deliver to the counterparty to the Forward Agreement a number of shares
of common stock (or, at the election of the Reporting Person, the cash
equivalent of such shares) based on the following:
(a) if the price per share of common stock, determined in
accordance with the terms of the tranche, for the Maturity
Date (the"Final Price") is equal to or less than the Floor
Price, the Reporting Person will deliver 250,000 shares;
(b) if the Final Price is greater than the Floor Price but less
than $40.00 (the "Cap Price"), the Reporting Person will
deliver a number of shares equal to Floor Price/Final Price x
250,000;
(c) if the Final Price is equal to or greater than the Cap Price,
the Reporting Person will deliver a number of shares equal to
the product of (i) 250,000 x (ii) the sum of (Floor
Price/Final Price) + (Final Price-Cap Price/Final Price).
In consideration of the second tranche of the Forward Agreement, the
Reporting Person received $5,273,434.53.
4. On June 10, 2004, the Reporting Person entered into a Prepaid Forward
Agreement (the "Forward Agreement") relating to the forward sale of up
to 750,000 shares of common stock in three tranches. On June 30, 2004,
the counterparty to the Forward Agreement sold 750,000 shares of common
stock into the public market in accordance with paragraphs (f) and (g)
of Rule 144 under the Securities Act of 1933, as amended, at a
weighted-average per share price equal to $25.8978 (the "Floor Price").
The terms of the third tranche provide that three business days after
March 30, 2006 (the "Maturity Date"), the Reporting Person will deliver
to the counterparty to the Forward Agreement a number of shares of
common stock (or, at the election of the Reporting Person, the cash
equivalent of such shares) based on the following:
(a) if the price per share of common stock, determined in
accordance with the terms of the tranche, for the Maturity
Date (the"Final Price") is equal to or less than the Floor
Price, the Reporting Person will deliver 250,000 shares;
(b) if the Final Price is greater than the Floor Price but less
than $42.00 (the "Cap Price"), the Reporting Person will
deliver a number of shares equal to Floor Price/Final Price x
250,000;
(c) if the Final Price is equal to or greater than the Cap Price,
the Reporting Person will deliver a number of shares equal to
the product of (i) 250,000 x (ii) the sum of (Floor
Price/Final Price) + (Final Price-Cap Price/Final Price).
In consideration of the third tranche of the Forward Agreement, the
Reporting Person received $5,121,937.40.
2