Annual Statement of Changes in Beneficial Ownership (5)
February 09 2017 - 04:08PM
Edgar (US Regulatory)
FORM 5
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
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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
*
FORD EDSEL B II
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2. Issuer Name
and
Ticker or Trading Symbol
FORD MOTOR CO [F]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
FORD MOTOR COMPANY, ONE AMERICAN ROAD
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2016
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(Street)
DEARBORN, MI 48126
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
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7. Nature of Indirect Beneficial Ownership
(Instr. 4)
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Amount
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(A) or (D)
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Price
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Common Stock, $0.01 par value
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2/4/2016
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G
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14580
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D
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$0.00
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125518
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D
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Common Stock, $0.01 par value
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3/23/2016
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G
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399000
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A
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$0.00
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525120
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D
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Common Stock, $0.01 par value
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4/13/2016
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G
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339435
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A
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$0.00
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864555
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D
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Common Stock, $0.01 par value
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4/21/2016
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G
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738435
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D
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$0.00
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126120
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D
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Common Stock, $0.01 par value
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12/27/2016
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G
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738435
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A
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$0.00
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877021
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D
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Common Stock, $0.01 par value
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12/28/2016
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G
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2240
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D
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$0.00
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874781
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D
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Common Stock, $0.01 par value
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2/4/2016
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G
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9720
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A
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$0.00
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867044
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I
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By Trust-Children
(1)
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Common Stock, $0.01 par value
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9/19/2016
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G
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35688
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A
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$0.00
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251938
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I
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as Trustee-Remainder Trusts
(2)
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Common Stock, $0.01 par value
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3/23/2016
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G
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399000
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D
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$0.00
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628731
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I
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By Annuity Trust
(3)
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Common Stock, $0.01 par value
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4/13/2016
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G
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339435
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D
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$0.00
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289296
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I
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By Annuity Trust
(3)
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Common Stock, $0.01 par value
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4/21/2016
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G
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738435
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A
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$0.00
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1027731
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I
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By Annuity Trust
(3)
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Common Stock, $0.01 par value
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12/27/2016
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G
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738435
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D
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$0.00
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289296
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I
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By Annuity Trust
(3)
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Class B Stock, $0.01 par value
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3/14/2016
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G
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2109
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D
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$0.00
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2133526
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I
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By Voting Trust-Children
(4)
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Class B Stock, $0.01 par value
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5/5/2016
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G
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2101
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D
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$0.00
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2131425
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I
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By Voting Trust-Children
(4)
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Class B Stock, $0.01 par value
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12/30/2016
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G
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2298
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D
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$0.00
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2129127
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I
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By Voting Trust-Children
(4)
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Class B Stock, $0.01 par value
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1803787
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I
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as Trustee-Remainder Trusts
(2)
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Class B Stock, $0.01 par value
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80
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I
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By Voting Trust
(5)
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Class B Stock, $0.01 par value
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32508
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I
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By Spouse
(6)
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Class B Stock, $0.01 par value
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1269672
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I
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as Trustee
(7)
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Common Stock, $0.01 par value
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20345
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I
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By Company Plan
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Common Stock, $0.01 par value
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24321
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I
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By Spouse
(6)
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Common Stock, $0.01 par value
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17346
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I
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as Trustee
(7)
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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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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Ford Stock Units
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(8)
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(8)
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Common Stock, $0.01 par value
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141577
(8)
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141577
(8)
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D
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Explanation of Responses:
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(
1)
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I am the trustee of these trusts for my children. I disclaim beneficial ownership of these shares.
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(
2)
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I am the trustee of these trusts for the benefit of my children's children. I disclaim beneficial ownership of these shares.
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(
3)
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These shares are held in a grantor retained annuity trust of which I am trustee.
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(
4)
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I am one of four trustees of the voting trust. As shown, it holds 2,129,127 shares of Class B Stock for the benefit of my children. I disclaim beneficial ownership of these shares.
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(
5)
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I am one of four trustees of the voting trust. As shown, it holds 80 shares of Class B Stock for my benefit. I disclaim beneficial ownership of any other shares of Class B Stock in said voting trust.
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(
6)
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I disclaim beneficial ownership of these shares owned by my wife.
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(
7)
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I am the trustee of this trust which holds these shares for the benefit of my children. I disclaim beneficial ownership of these shares.
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(
8)
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These Ford Stock Units were acquired under the Company's Deferred Compensation Plan for Non-Employee Directors. In general, these Ford Stock Units will be converted and distributed to me, without payment, in cash, on January 10th of the year following termination of Board service, based upon the then current market value of a share of Common Stock.
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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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FORD EDSEL B II
FORD MOTOR COMPANY
ONE AMERICAN ROAD
DEARBORN, MI 48126
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X
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Signatures
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Jerome F. Zaremba,
Attorney-in-Fact
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2/9/2017
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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 4(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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