SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Potter Beth

(Last) (First) (Middle)
864 SPRING STREET NW

(Street)
ATLANTA GA 30308

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
NCR CORP [ NCR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
CAO
3. Date of Earliest Transaction (Month/Day/Year)
02/21/2020
4. If Amendment, Date of Original Filed (Month/Day/Year)
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. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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)
Code V Amount (A) or (D) Price
Common Stock 02/23/2020 M 347(1) A $12.81 22,275 D
Common Stock 02/23/2020 F 61(2) D $31.28 22,214 D
Common Stock 02/23/2020 F 205(3) D $31.28 22,009 D
Common Stock 02/24/2020 M 6,698(4) A $29.64 28,707 D
Common Stock 02/24/2020 F 2,017 D $29.64 26,690 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: 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
Restricted Stock Units $12.81 02/23/2020 M 347(5) 02/23/2011 02/23/2020 Common Stock 347 $0.00 0 D
Restricted Stock Units $0.00(4) 02/24/2020 M 6,698(4) (4) (4) Common Stock 6,698 $0.00 6,698 D
Explanation of Responses:
1. The exercise and sale reported in this Form 4 occurred pursuant to the automatic option exercise of a stock option per Company policy on the option expiration date.
2. These shares were withheld to cover tax withholdings obligations upon the exercise or the option reported in this Form 4. These shares were rounded to 61 for disclosure in this table.
3. These shares were withheld to cover tax withholding obligations when 678 previously reported restricted stock units vested on February 23, 2020.
4. Represents the conversion of restricted stock units that vested on February 24, 2020. The performance related conditions of these restricted stock units were satisfied on December 9, 2016.
5. The exercise and sale reported in this Form 4 occurred pursuant to the automatic exercise of a stock option per Company policy on the option expiration date.
Remarks:
Laura J. Foltz, Attorney-in-Fact for Beth Potter 02/25/2020
** 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).
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