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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
PERELMAN RONALD O 35 EAST 62ND STREET NEW YORK, NY 10065 |
X | X | ||
RCH Holdings One Inc C/O MACANDREWS & FORBES HOLDINGS INC. 35 EAST 62ND STREET NEW YORK, NY 10065 |
X |
/s/ Barry F. Schwartz for Ronald O. Perelman pursuant to a Power of Attorney | 10/13/2009 | |
**Signature of Reporting Person | Date | |
/s/ Barry F. Schwartz, its Executive Vice Chairman | 10/13/2009 | |
**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) | Includes 4,561,610 shares of Class A Common Stock of Revlon, Inc. ("Revlon") beneficially owned by a family member with respect to which shares MacAndrews & Forbes Holdings Inc., a corporation wholly owned by Ronald O. Perelman, holds a voting proxy. Does not include 3,125,000 shares of Revlon Class B Common Stock also beneficially owned by Mr. Perelman. |
(2) | Pursuant to the Contribution and Stockholder Agreement, dated as of August 9, 2009, as amended, by and between Revlon and MacAndrews & Forbes Holdings Inc., in connection with the closing of an exchange offer by Revlon (the "Exchange Offer"), Revlon issued to a subsidiary of MacAndrews & Forbes Holdings Inc. 9,336,905 shares of Class A Common Stock in the aggregate, in connection with the transactions forming part of the Exchange Offer (9,332,393 of the shares of Class A Common Stock were issued on October 8, 2009 upon the consummation of the Exchange Offer and 4,512 of the shares of Class A Common Stock were issued on October 12, 2009 after Revlon received 4,512 shares tendered in the Exchange Offer pursuant to guaranteed delivery procedures). The transactions reported on this Form 4 will be reported on a Schedule 13D filed no later than October 19, 2009. |
(3) | A holding company in which each of Mr. Perelman and the Ronald O. Perelman 2008 Trust own 50% of the shares. |