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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 | ||||||||
Shares of LIPO Investments (Canada), Inc. | (1) | 07/26/2007 | J(1) | 6,818,182 (1) | (3) | (4) | Common Stock | 6,818,182 | $ 0 | 0 | D | ||||
Shares of LIPO Investments (Canada), Inc. | (5) | 07/26/2007 | J(5) | 19,516,615 (5) | (3) | (4) | Exchangeable Shares (5) | 19,516,615 | $ 0 | 0 | D | ||||
Series TS Preferred Stock | (2) | 07/26/2007 | J(2) | 116,994 | (3) | (4) | Common Stock | 6,092,171 | $ 0 | 0 | D | ||||
Exchangeable Shares of Lulu Canadian Holding, Inc. | (6) | 07/26/2007 | J(1) | 19,516,615 | (3) | (4) | Common Stock | 19,516,615 | $ 0 | 19,516,615 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Wilson Dennis J. C/O LULULEMON ATHLETICA 2285 CLARK DRIVE VANCOUVER, A1 V5N 3G9 |
X | X | Chairman&ChiefProductDesigner |
/s/ Dennis J. Wilson | 07/26/2007 | |
**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) | Shares of LIPO Investments (Canada), Inc. were exchanged for common stock of the Issuer on the effective date of the Issuer's initial public offering in a corporate reorganization exempt from Section 16(b) under Rules 16b-7 and 16b-3. |
(2) | Shares of Series TS Preferred Stock were exchanged for shares of common stock of the Issuer on the effective date of the Issuer's initial public offering in a corporate reorganization exempt from Section 16(b) under Rules 16b-7 and 16b-3. |
(3) | Immediately exercisable. |
(4) | No expiration date. |
(5) | Shares of LIPO Investments (Canada), Inc. were exchanged for exchangeable shares of Lulu Canadian Holding, Inc. on the effective date of the Issuer's initial public offering in a corporate reorganization exempt from Section 16(b) under Rules 16b-7 and 16b-3. The exchangeable shares of Lulu Canadian Holding, Inc. are exchangeable for shares of the Issuer's common stock on a 1-for-1 basis. |
(6) | 1-to-1 exchange ratio. |