Annual Statement of Changes in Beneficial Ownership (5)
February 15 2017 - 3:11PM
Edgar (US Regulatory)
FORM 5
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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
*
KIM JOHN T
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2. Issuer Name
and
Ticker or Trading Symbol
AMKOR TECHNOLOGY, INC. [AMKR]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
__
X
__ Other (specify below)
Exhibit 99.1
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(Last)
(First)
(Middle)
2045 EAST INNOVATION CIRCLE
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2016
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(Street)
TEMPE, AZ 85284
(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
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2/1/2016
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J
(1)
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2413880
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D
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$5.96
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25824640
(4)
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I
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By self as trustee
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Common Stock
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2/1/2016
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J
(1)
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2413880
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A
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$5.96
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25824640
(4)
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I
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By self as trustee
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Common Stock
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7/18/2016
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J
(2)
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568780
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D
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$6.09
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25824640
(4)
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I
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By self as trustee
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Common Stock
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11/3/2016
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J
(3)
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1414250
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D
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$10.40
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25824640
(4)
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I
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By self as trustee
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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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Explanation of Responses:
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(
1)
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On February 1, 2016, the John T. Kim Irrevocable Trust U/A Dated 12/11/12 distributed 2,413,880 shares to the John T. Kim Trust of December 31, 1987. John T. Kim and James J. Kim are trustees of the John T. Kim Irrevocable Trust U/A Dated 12/11/12. John T. Kim is the sole trustee of the John T. Kim Trust of December 31, 1987.
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(
2)
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On July 18, 2016, the Susan Y. Kim 2015 Irrevocable Trust U/A Dated 3/16/15 distributed 568,780 shares of the Company's Common Stock to Susan Y. Kim. Susan Y. Kim and John T. Kim are co-trustees.
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(
3)
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On November 3, 2016, the Susan Y. Kim 2012 Irrevocable Trust U/A Dated 7/26/12 distributed 1,414,250 shares of the Company's Common Stock to Susan Y. Kim. Susan T. Kim and John T. Kim are trustees of the trust.
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(
4)
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The reporting person disclaims beneficial ownership of these securities, except to the extent of the reporting person's pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities, except to the extent of the reporting person's pecuniary interest therein, for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose.
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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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KIM JOHN T
2045 EAST INNOVATION CIRCLE
TEMPE, AZ 85284
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X
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X
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Exhibit 99.1
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Signatures
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Jerry Allison, as Attorney in Fact
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2/15/2017
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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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