[X] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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(f) of the Investment Company Act of 1940 |
OMB Number: 3235-0287 Expires: December 31, 2001 Estimated average burden hours per response. . . . . 0.5 |
1. Name and Address of Reporting Person* Melvin, Carolyn S. |
2. Issuer Name and Ticker or Trading Symbol Alliance Data Systems Corporation ADS 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) |
4. Statement for (Month/Year) September 2001 5. If Amendment, Date of Original (Month/Year) |
6. Relationship of Reporting Person(s) to Issuer Director 10% Owner X Officer Other Officer/Other Description Senior Vice President and Assistant General Counsel 7. Individual or Joint/Group Filing (Check Applicable Line) X Individual Filing Joint/Group Filing |
1. Title of Security (Instr. 3) |
2. Transaction Date (Month/Day/Year) |
3. Transaction Code and Voluntary Code (Instr. 8) |
4. Securities Acquired (A) or Disposed (D) Of (Instr. 3, 4, and 5) |
5. Amount of Securities Beneficially Owned at End of Month (Instr. 3 and 4) |
6. Owner- ship Form: Direct(D) or Indirect (I) (Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Common | |
13,000 (1) | ||||
Melvin, Carolyn S. - September 2001 |
Form 4 (continued) |
(e.g., puts, calls, warrants, options, convertible securities) |
1. Title of Derivative Security (Instr. 3) |
2. Conver- sion or Exercise Price of Deri- vative Security |
3. Transaction Date (Month/ Day/ Year) |
4. Transaction Code and Voluntary (V) Code (Instr.8) |
5. Number of Derivative Securities Acquired (A) or Disposed (D) Of (Instr. 3,4 and 5) |
6. Date Exercisable(DE) and Expiration Date(ED) (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 at End of Month (Instr.4) |
10. Owner- ship Form of Deriv- ative Security: Direct (D) or Indirect (I) |
11. Nature of Indirect Beneficial Ownership (Instr.4) |
Employee Stock Option (right to buy) |
$9.00 | |
Common - 11,111 | |
11,111 | |||||
Employee Stock Option (right to buy) |
$9.00 | |
Common - 1,111 | |
1,111 | |||||
Employee Stock Option (right to buy) |
$9.90 | |
Common - 10,000 | |
10,000 | |||||
Employee Stock Option (right to buy) |
$15.00 | |
Common - 50,000 | |
50,000 | |||||
Employee Stock Option (right to buy) |
$12.00 | |
Common - 23,780 | |
23,780 | |||||
** 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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number. |
________________________________ __________________ ** Signature of Reporting Person Date Attorney-in-Fact for Carolyn S. Melvin Page 2 |
Melvin, Carolyn S. - September 2001 |
Form 4 (continued) |
Form 4 - September 2001 Carolyn S. Melvin17655 Waterview Parkway Dallas, TX 75252-8012 Explanation of responses: (1) Includes 9,600 unvested shares of common stock pursuant to a restricted stock grant. (2) The option is exercisable for 2,500 shares on 1/31/97, 4,305 shares on 1/31/99, and 4,306 shares on 1/31/00. (3) The option is exercisable for 417 shares on each of 1/31/99 and 1/31/00, and for 277 shares on 1/31/01. (4) The option is exercisable for 2,500 shares on each of 1/31/00, 1/31/01 and 1/31/02. (5) The option is exercisable for 16,500 shares on each of 8/31/01 and 8/31/02, and for 17,000 shares on 8/31/03. (6) The option is exercisable for 33% of the underlying shares on each of 8/31/01 and 8/31/02, and for 34% on 8/31/03. |
Page 3 |