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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT 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 1474 (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 Following Reported Transaction(s) (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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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Restricted Stock Units | $ 0 | 02/22/2005 | A | 13,333 | (3) | (3) | Common Stock | 13,333 | $ 0 | 13,333 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Roberts Scott W 97 DARLING AVENUE SOUTH PORTLAND, ME 04106 |
SVP, Strat. Planning & Dvlp. |
Hilary A. Rapkin, as attorney-in-fact for Scott W. Roberts | 02/24/2005 | |
**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) | Securities were granted under the Wright Express Corporation ("Wright Express") 2005 Equity and Incentive Plan in connection with the initial public offering of Wright Express and the reporting person's surrender of restricted stock units of Cendant Corporation ("Cendant"), the parent of Wright Express prior to the initial public offering, and stock options to purchase Cendant common stock. |
(2) | Represents tax witholdings in connection with the surrender of restricted stock units of Cendant in exchange for common stock of Wright Express. |
(3) | Restricted Stock Units will become exercisable with respect to 25% of the shares on each of the first four anniversaries of the date of grant. |