SEC FORM
3
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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O FARO TECHNOLOGIES, INC. |
| 250 TECHNOLOGY PARK |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
02/14/2019
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3. Issuer Name and Ticker or Trading Symbol
FARO TECHNOLOGIES INC
[ FARO ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
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10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Chief R&D Officer |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Stock |
3,533
|
D |
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Employee Stock Option (right to buy) |
03/02/2019 |
03/02/2023 |
Common Stock |
2,560 |
33.05 |
D |
|
| Employee Stock Option (right to buy) |
|
03/03/2024 |
Common Stock |
11,612 |
34.55 |
D |
|
| Employee Stock Option (right to buy) |
|
03/20/2025 |
Common Stock |
7,550 |
61.3 |
D |
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| Employee Stock Option (right to buy) |
|
02/27/2025 |
Common Stock |
1,508 |
59.97 |
D |
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| Explanation of Responses: |
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|
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| Remarks: |
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/s/ Jody S. Gale, attorney-in-fact for Yazid Tohme (power of attorney filed herewith) |
02/25/2019 |
|
** 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. |
POWER OF ATTORNEY
For Executing a Form ID and Forms 3, 4, 5 and 144
The undersigned hereby appoints each of Jody Gale and
Robert E. Seidel, Jr., signing singly, as his true
and lawful attorney-in-fact, for such period of time
that the undersigned is required to file reports
pursuant to Section 16(a) of the Securities Exchange Act
of 1934, as amended (the "Exchange Act"), or Rule 144
of the Securities Act of 1933, as amended (the "Securities
Act"), due to his affiliation with FARO Technologies,
Inc., a Florida corporation, unless earlier revoked by
the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact, to:
1 execute for and on behalf of the undersigned a Form ID
application for access codes to file on EDGAR and Forms 3, 4,
5 and 144 and any amendments to previously filed forms in
accordance with Section 16(a) of the Exchange Act or Rule 144
of the Securities Act and the rules thereunder;
2 do and perform any and all acts for and on behalf of the
undersigned which may be necessary or desirable to complete
the execution of any such Form ID and Forms 3, 4, 5 and 144
and the timely filing of such form with the United States
Securities and Exchange Commission and any other authority
as required by law; and
3 take any other action of any type whatsoever in connection
with the foregoing which, in the opinion of such attorney-in-fact,
may be of benefit to, in the best interest of, or legally required
by, the undersigned, it being understood that the documents executed
by such attorney-in-fact on behalf of the undersigned pursuant to this
Power of Attorney shall be in such form and shall contain such terms
and conditions as such attorney-in-fact may approve in his discretion.
The undersigned hereby grants to each such attorney-in-fact full
power and authority to do and perform all and every act and thing
whatsoever requisite, necessary and proper to be done in the exercise
of any of the rights and powers herein granted, as fully to all intents
and purposes as the undersigned could do if personally present, with full
power of substitution or revocation, hereby ratifying and confirming all that
such attorney-in-fact, or his substitute or substitutes, shall lawfully do or
cause to be done by virtue of this Power of Attorney and the rights and
powers herein granted. The undersigned acknowledges that the foregoing
attorneys-in-fact, in serving in such capacity at the request of the undersigned,
are not assuming any of the undersigned's responsibilities to comply
with Section 16 of the Exchange Act or Rule 144 of the Securities Act.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney
to be executed as of this 15th day of February, 2019.
/s/ Yazid Tohme
Yazid Tohm
