Initial Statement of Beneficial Ownership (3)
June 07 2016 - 12:40PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Evans Steve Andrew
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/31/2016
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3. Issuer Name
and
Ticker or Trading Symbol
Fossil Group, Inc. [FOSL]
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(Last)
(First)
(Middle)
901 S. CENTRAL EXPRESSWAY
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Executive Vice President /
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(Street)
RICHARDSON, TX 75080
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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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
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16708
(1)
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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 Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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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 of Derivative Security: 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
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Appreciation Right
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7/15/2015
(2)
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7/15/2022
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Common Stock
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5101
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$101.365
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D
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Stock Appreciation Right
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3/15/2016
(3)
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3/15/2023
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Common Stock
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5295
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$80.215
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D
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Stock Appreciation Right
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3/15/2017
(4)
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3/15/2024
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Common Stock
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10287
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$47.985
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D
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Explanation of Responses:
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(
1)
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This amount includes 15,572 restricted stock units [Vests as 576 on 7/15/16, 575 on 7/15/17; 1432 on 3/15/17, 1431 on 3/15/18, 912 on 3/15/19; 3549 on 11/24/16, 3549 on 11/24/17, and 3548 on 11/24/18] and also includes 341 shares held through a 401(k) plan account as of 6/1/16.
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(
2)
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Exercisable as to 1/3 on 7/15/15; as to 1/3 on 7/15/16; and as to 1/3 on 7/15/17, cumulatively.
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(
3)
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Exercisable as to 1/3 on 3/15/16; as to 1/3 on 3/15/17; and as to 1/3 on 3/15/18, cumulatively.
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(
4)
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Exercisable as to 1/3 on 3/15/17; as to 1/3 on 3/15/18; and as to 1/3 on 3/15/19, cumulatively.
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Remarks:
POWER OF ATTORNEY: KNOW ALL MEN BY THESE PRESENTS, that Steve Andrew Evans hereby constitutes and appoints Randy S. Hyne as attorney-in-fact with power and authority to act on behalf of the undersigned as follows: To execute and file with the United States Securities and Exchange Commission Forms 3, 4, 5, and 144, and any amendments thereto, regarding transactions in Fossil Group, Inc. stock. Any person receiving a duly executed copy or facsimile of this instrument may rely on the authority of the attorney-in-fact as hereinabove set forth, and revocation or termination of this Power of Attorney by operation of law or otherwise shall be ineffective as to such person unless and until such person receives actual notice or knowledge of such revocation. IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this 2nd day of June, 2016.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Evans Steve Andrew
901 S. CENTRAL EXPRESSWAY
RICHARDSON, TX 75080
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Executive Vice President
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Signatures
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/s/ Steve Andrew Evans
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6/7/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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