SEC FORM
5
SEC Form 5
| FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL 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
|
| OMB APPROVAL |
| OMB Number: |
3235-0362 |
| Estimated average burden |
| hours per response: |
1.0 |
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|
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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). |
|
Form 3 Holdings Reported. |
|
Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
| C/O SIANA CARR O'CONNOR & LYNAM, |
| 1500 EAST LANCASTER AVENUE |
(Street)
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2. Issuer Name and Ticker or Trading Symbol
AMKOR TECHNOLOGY, INC.
[ AMKR ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
| Exhibit 99.1 |
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year)
12/31/2017
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
|---|
| 1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Amount |
(A) or (D) |
Price |
| Common Stock |
09/11/2017 |
|
J
|
686,108 |
D |
$9.06
|
3,220,433 |
D |
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
|
| (A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
|
| Remarks: |
|
|
Christie B. Tillapaugh, as Attorney in Fact |
02/14/2018 |
|
** 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). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| 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 Number. |
LIMITED POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby makes, constitutes
and appoints Jerry Allison, Gil C. Tily, Christie B. Tillapaugh and Richard D.
Rosen (any of whom may act individually) as the true and lawful attorney-in-fact
of the undersigned, with full power and authority as hereinafter described on
behalf of and in the name, place and stead of the undersigned to:
(1) prepare, execute, acknowledge, deliver and file Forms 3, 4, and 5
(including any amendments thereto) and any Schedule 13D (including any
amendments thereto) with respect to the securities of Amkor Technology, Inc., a
Delaware corporation (the "Company"), with the United States Securities and
Exchange Commission, any national securities exchanges and the Company, as
considered necessary or advisable under Section 16(a) of the Securities Exchange
Act of 1934 and the rules and regulations promulgated thereunder, as amended
from time to time (the "Exchange Act"), including obtaining any filing codes or
reissuance of existing filing codes, if necessary, in connection therewith;
(2) seek or obtain, as the undersigned's representative and on behalf of the
undersigned, information on transactions in the Company's securities from any
third party, including brokers, employee benefit plan administrators and
trustees, and the undersigned hereby authorizes any such person to release any
such information to such attorney-in-fact and approves and ratifies any such
release of information; and
(3) perform any and all other acts which in the discretion of such attorney-in-
fact are necessary or desirable for and on behalf of the undersigned in
connection with the foregoing.
The undersigned acknowledges that:
(1) this Power of Attorney authorizes, but does not require, such attorney-in-
fact to act in his or her discretion on information provided to such attorney-
in-fact without independent verification of such information;
(2) any documents prepared and/or executed by such attorney-in-fact on behalf
of any of the undersigned pursuant to this Power of Attorney will be in such
form and will contain such information and disclosure as such attorney-in-fact,
in his or her discretion, deems necessary or desirable;
(3) neither the Company nor such attorney-in-fact assumes (i) any liability for
the undersigned's responsibility to comply with the requirements of the Exchange
Act, (ii) any liability of the undersigned for any failure to comply with such
requirements, or (iii) any obligation or liability of any of the undersigned for
profit disgorgement under Section 16(b) of the Exchange Act;
(4) this Power of Attorney does not relieve the undersigned from responsibility
for compliance with the undersigned's obligations under the Exchange Act,
including without limitation the reporting requirements under Section 16 of the
Exchange Act; and
(5) this Power of Attorney supersedes and replaces any prior power of attorney
executed by the undersigned for any of the purposes set forth herein.
Although this Power of Attorney supersedes and replaces any prior power of
attorney executed by the undersigned for any of the purposes set forth herein,
the undersigned hereby ratifies and approves of any actions taken pursuant to
any prior power of attorney for any of the purposes set forth herein, including
without limitation the granting thereof by the undersigned on his or her behalf.
The undersigned hereby gives and grants the foregoing attorney-in-fact full
power and authority to do and perform all and every act and thing whatsoever
requisite, necessary or appropriate to be done in and about the foregoing
matters as fully to all intents and purposes as the undersigned might or could
do if present, hereby ratifying all that such attorney-in-fact shall lawfully do
or cause to be done of, for and on behalf of the undersigned by virtue of this
Power of Attorney.
This Power of Attorney may be executed in several counterparts (if
applicable), each of which shall be deemed an original but all of which shall
constitute one and the same instrument.
This Power of Attorney shall remain in full force and effect until revoked
by the undersigned in a signed writing delivered to the attorney-in-fact.
Signature Page to Limited Power of Attorney
IN WITNESS WHEREOF, the undersigned have each caused this Power of Attorney to
be executed as of the 19th day of June, 2013.
Name of individual and/or entity covered by this Power of Attorney: James J. Kim
2013 Qualified Annuity Trust U/A Dated May 17, 2013.
By: /s/ Susan Y. Kim
-----------------
Name: Susan Y. Kim
Title: Trustee
Signature Page to Limited Power of Attorney
IN WITNESS WHEREOF, the undersigned have each caused this Power of Attorney
to be executed as of the 18th day of June, 2013.
Name of individual and/or entity covered by this Power of Attorney: James J. Kim
2013 Qualified Annuity Trust U/A Dated May 17, 2013.
By: /s/ James J. Kim
-----------------
Name: James J. Kim
Title: Trustee
Exhibit 99.1
A Schedule 13D was filed by James J. Kim and those members of the reporting
group who then constituted the group on November 28, 2005, as amended by
Amendment No. 1 filed with the Securities and Exchange Commission (the
"Commission") on April 4, 2008, Amendment No. 2 filed with the Commission on
March 19, 2009, Amendment No. 3 filed with the Commission on April 16, 2009,
Amendment No. 4 filed with the Commission on February 5, 2010, Amendment No. 5
filed with the Commission on March 28, 2011, Amendment No. 6 filed with the
Commission on November 17, 2011, Amendment No. 7 filed with the Commission on
March 29, 2013, Amendment No. 8 filed with the Commission on March 28, 2014,
Amendment No. 9 filed with the Commission on March 30, 2015, Amendment No. 10
filed with the Commission on March 30, 2016, and Amendment No. 11 filed with the
Commission on January 20, 2017, (as further amended from time to time, the
"Schedule 13D"). Those individuals and entities listed in the Schedule 13D,
including the filer of this Form 5, may be deemed to be members of a group (the
"Group") who each exercise voting or investment power with respect to shares of
Amkor Technology, Inc.'s (the "Issuer") Common Stock in concert with other
members of the Group. The Group may be deemed to beneficially own more than 10%
of the outstanding voting securities of the Issuer. The reporting person states
that the filing of this Form 5 Report shall not be deemed an admission that the
reporting person is the beneficial owner of the reported securities owned by the
other members of the Group, for the purpose of Section 16 of the Securities
Exchange Act of 1934, as amended, or for any other purpose.
