Annual Statement of Changes in Beneficial Ownership (5)
13 Mai 2022 - 10:34PM
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 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0362
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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
*
BARBOUR D. SCOTT | 2. Issuer Name and Ticker or Trading SymbolADVANCED DRAINAGE SYSTEMS, INC. [WMS] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) President and Chief Executive |
(Last)
(First)
(Middle)
C/O ADVANCED DRAINAGE SYSTEMS, INC., 4640 TRUEMAN BOULEVARD | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 3/31/2022 |
(Street)
HILLIARD, OH 43026
(City)
(State)
(Zip)
| 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
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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) | 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 |
Common Stock | 10/21/2021 | | G (1) | 90920 | D | $0.00 | 89554 | D | |
Common Stock | 10/21/2021 | | G (2) | 60000 | D | $0.00 | 29544 | D | |
Common Stock | | | | | | | 90920 | I | Reporting Person's Revocable Trust |
Common Stock | | | | | | | 60000 | I | Spouse's Revocable Trust |
Common Stock | 10/29/2021 | | G (3) | 82000 | D | $0.00 | 8920 | I | Reporting Person's Revocable Trust |
Common Stock | 11/3/2021 | | G (4) | 50000 | D | $0.00 | 10000 | I | Spouse's Revocable Trust |
Common Stock | | | | | | | 82000 | I | Reporting Person's Irrevocable Trust |
Common Stock | | | | | | | 50000 | I | Spouse's Irrevocable Trust |
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) | 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 |
Explanation of Responses: |
(1) | On October 21, 2021, the reporting person contributed 90,920 shares of common stock of Advanced Drainage Systems, Inc. ("ADS") to a revocable trust for the benefit of the reporting person. |
(2) | On October 21, 2021, the reporting person contributed 60,000 shares of ADS common stock to a revocable trust for the benefit of the reporting person's spouse. |
(3) | On October 29, 2021 the revocable trust for the benefit of the reporting person contributed 82,000 shares of ADS common stock to an irrevocable spousal access trust established by the reporting person, of which the reporting person's spouse is a co-trustee. The beneficiaries of the irrevocable trust are the reporting person and his children. |
(4) | On November 3, 2021, the revocable trust for the benefit of the reporting person's spouse contributed 50,000 shares of ADS common stock to an irrevocable spousal access trust established by the reporting person's spouse, of which the reporting person is a co-trustee. The beneficiaries of the irerrevocable trust include the reporting person's spouse and his children. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
BARBOUR D. SCOTT C/O ADVANCED DRAINAGE SYSTEMS, INC. 4640 TRUEMAN BOULEVARD HILLIARD, OH 43026 | X |
| President and Chief Executive |
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Signatures
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/s/ D. Scott Barbour | | 5/13/2022 |
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* | 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). |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
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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