Annual Statement of Changes in Beneficial Ownership (5)
12 Januar 2022 - 04:19PM
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).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
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 * Clark Stanley L |
2. Issuer Name and Ticker or Trading
SymbolAMPHENOL CORP /DE/ [APH] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
|
|
(Last)
(First)
(Middle)
C/O AMPHENOL CORPORATION, 358 HALL AVENUE |
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2021
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(Street)
WALLINGFORD, CT 06492
(City)
(State)
(Zip)
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4. 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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership
(Instr. 4) |
|
Amount |
(A) or (D) |
Price |
Table II - Derivative Securities Acquired, Disposed of, or
Beneficially Owned (e.g., puts, calls, warrants, options,
convertible securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. 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
(MM/DD/YYYY) |
7. Title and Amount of Securities Underlying
Derivative Security
(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) |
|
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
|
Phantom Stock (1) |
$0 |
4/1/2021 |
|
A |
66.65 |
|
(2) |
(2) |
Class A Common Stock |
66.65 |
$67.00 |
35791.43 |
D |
|
|
Phantom Stock (1) |
$0 |
7/1/2021 |
|
A |
76.65 |
|
(2) |
(2) |
Class A Common Stock |
76.65 |
$67.71 |
35868.08 |
D |
|
|
Phantom Stock (1) |
$0 |
10/1/2021 |
|
A |
74.46 |
|
(2) |
(2) |
Class A Common Stock |
74.46 |
$69.85 |
35942.54 |
D |
|
|
Phantom Stock (1) |
$0 |
1/1/2022 |
|
A |
70.02 |
|
(2) |
(2) |
Class A Common Stock |
70.02 |
$74.43 |
36012.56 |
D |
|
| Explanation of
Responses: |
| (1) |
Phantom Stock Units convert
to Class A Common Stock on a one-for-one basis. |
| (2) |
Not applicable. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Clark Stanley L
C/O AMPHENOL CORPORATION
358 HALL AVENUE
WALLINGFORD, CT 06492 |
X |
|
|
|
Signatures
|
|
/s/ Lance E. D'Amico, POA |
|
1/12/2022 |
| **Signature of Reporting
Person |
Date |
Amphenol (NYSE:APH)
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