|
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 |
|
| |||||||||||||||||||||||||||||
|
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) |
||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Exchangeable Shares of Lulu Canadian Holding, Inc. | (1) | 12/21/2009 | J(2) | 40,664 | (3) | (4) | Common Stock | 40,664 | $ 0 | 18,972,728 | D | ||||
Exchangeable Shares of Lulu Canadian Holding, Inc. | (1) | 12/21/2009 | J(5) | 2,838 | (3) | (4) | Common Stock | 2,838 | $ 0 | 134,492 (6) | I | By Wife | |||
Exchangeable Shares of Lulu Canadian Holding, Inc. | (1) | (3) | (4) | Common Stock | 0 | 43,928 (7) | I | By Five Boys Investments ULC |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Wilson Dennis J. 2285 CLARK DRIVE VANCOUVER, A1 V5N 3G9 |
X | X | Chairman and Chief Prod Design |
Dennis J. Wilson, by David Negus, Attorney-in-Fact | 12/23/2009 | |
**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) | 1-to-1 exchange ratio. |
(2) | Represents the distribution of exchangeable shares of Lulu Candian Holding, Inc. held in trust for employees of lululemon athletica inc. to the beneficiaries for no consideration. |
(3) | Immediately exchangeable for shares of lululemon common stock on a 1-to-1 basis. |
(4) | No expiration date. |
(5) | Represents a change in the form of beneficial ownership from direct to indirect in a trust distribution exempt under Rule 16a-13. |
(6) | Of these shares, 95,797 were acquired on July 26, 2007 in a trust distribution exempt under Rule 16a-13, representing a change in the form of beneficial ownership from direct to indirect. |
(7) | Of these shares, 2,493 were acquired on July 26, 2007 upon the exchange of shares of LIPO Investments (Canada), Inc. for exchangeable shares of Lulu Canadian Holding, Inc. in a corporate reorganization exempt from Section 16(b) under Rules 16b-7 and 16b-3. |