Initial Statement of Beneficial Ownership (3)
November 14 2019 - 4:05PM
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
*
Potter Beth |
2. Date of Event Requiring Statement (MM/DD/YYYY)
11/5/2019
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3. Issuer Name and Ticker or Trading Symbol
NCR CORP [NCR]
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(Last)
(First)
(Middle)
864 SPRING STREET NW |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
CAO / |
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(Street)
ATLANTA, GA 30308
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 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) |
| CommonStock | 10231 (1) | D | |
| Common Stock | 4731 (2) | D | |
| Common Stock | 1356 (3) | D | |
| Common Stock | 424 (4) | D | |
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) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 | (5) | (5) | Common Stock | 6698 | $0.00 | D | |
| Employee Stock Options (right to buy) | 2/23/2011 (6) | 2/22/2020 (6) | Common Stock | 347 | $12.81 | D | |
| Explanation of Responses: |
| (1) | Consists of 10,230.8283 shares rounded to 10,231 for disclosure on this table. |
| (2) | These are time-based restricted stock units granted February 8, 2019 that will vest ratably, with 1/3 of such units vesting on each of the first, second and third anniversaries of the grant date (each a "Vesting Date"), subject to the reporting person's continued employment with the issuer on the applicable Vesting Dates, and in accordance with the terms and conditions of the applicable award agreement. |
| (3) | These are time-based restricted stock units granted February 23, 2018 that will vest ratably, with 1/2 of such units vesting on each of the second and third anniversaries of the grant date (each a "Vesting Date"), subject to the reporting person's continued employment with the issuer on the applicable Vesting Dates, and in accordance with the terms and conditions of the applicable award agreement. |
| (4) | These are time-based restricted stock units granted February 27, 2017 that will vest on February 27, 2020 subject to the reporting person's continued employment with the issuer on that date and in accordance with the terms and conditions of the applicable award agreement. |
| (5) | These are price-contingent restricted stock units granted on February 24, 2016 as to which the price-related performance conditions to vesting have been satisfied. Vesting of these units is conditioned on continued service with the issuer through the fourth anniversary of the grant date to the extent required in the applicable award agreement. |
| (6) | These options are fully vested. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Potter Beth
864 SPRING STREET NW
ATLANTA, GA 30308 |
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| CAO |
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Signatures
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| Laura J. Foltz as Attorney-in Fact for Beth Potter | | 11/14/2019 |
| **Signature of Reporting Person | Date |
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