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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | 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. | SEC 2270 (9-02) |
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 Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
LEIBOWITZ REUBEN S 551 MADISON AVENUE, SUITE 300 NEW YORK, NY 10022 |
 X |  |  |  |
/s/ Reuben S. Leibowitz, by his attorney-in-fact, Steven Fivel | 02/14/2017 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Represents a gift to the Leibowitz Foundation, as indicated in footnote (3). |
(2) | The reporting person disclaims beneficial ownership of these securities and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of the reported shares for purposes of Section 16 or for any other purposes. |
(3) | The reporting person last disclosed the holdings of the Leibowitz Foundation in a Form 4 filed on May 23, 2011. At that time, due to a clerical error he reported ownership of 2,496 shares of Common Stock instead of 2,500 shares. Between the date of that report on Form 4 and December 28, 2016 the Leibowitz Foundation neither acquired nor disposed of any Common Stock; however the reporting person inadvertently did not include the Leibowitz Foundation's ownership of Common Stock in the Forms 4 he filed subsequent to May 23, 2011. This Form 5 reflects the 2,500 shares previously owned by the Leibowitz Foundation plus the reporting person's gift of 2,500 shares of Common Stock to the Leibowitz Foundation. |
(4) | The reporting person last disclosed the holdings of the Maxsim Charitable Remainder Trust in a Form 4 on May 23, 2011. At that time, due to a clerical error he reported ownership of 932 shares of Common Stock through the Reuben S. Leibowitz Trust instead of the Maxsim Charitable Remainder Trust. Between the date of that report on Form 4 and February 14, 2017 the Maxsim Charitable Remainder Trust neither acquired nor disposed of any Common Stock; however the reporting person inadvertently did not include the Maxsim Charitable Remainder Trust's ownership of Common Stock in the Forms 4 he filed subsequent to May 23, 2011. |
(5) | The reporting person last disclosed the holdings of the Sarah Lea & Jesse Z. Shafer Charitable Medical Trust in a Form 4 on May 23, 2011. At that time, due to a clerical error he reported ownership of 2,564 shares of Common Stock instead of 1,000 shares of Common Stock. Between the date of that report on Form 4 and February 14, 2017 the Sarah Lea & Jesse Z. Shafer Charitable Medical Trust neither acquired nor disposed of any Common Stock; however the reporting person inadvertently did not include the Sarah Lea & Jesse Z. Shafer Charitable Medical Trust's ownership of Common Stock in the Forms 4 he filed subsequent to May 23, 2011. |