- Statement of Changes in Beneficial Ownership (4)
10 February 2010 - 11:48AM
Edgar (US Regulatory)
FORM 4
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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February 28, 2011
Estimated average burden
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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
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1. Name and Address of Reporting Person
*
Burlin Tom
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2. Issuer Name
and
Ticker or Trading Symbol
AFFILIATED COMPUTER SERVICES INC
[
ACS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Executive Vice President
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(Last)
(First)
(Middle)
9763 HAWKINS CREAMERY ROAD
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3. Date of Earliest Transaction
(MM/DD/YYYY)
2/5/2010
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(Street)
LAYTONSVILLE, MD 20882
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. 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 Following Reported Transaction(s)
(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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Code
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V
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Amount
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(A) or (D)
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Price
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Class A Common Stock $0.01 par value
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2/5/2010
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D
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1100
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D
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(1)
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0
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. 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
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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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option (Right to Buy)
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$44.81
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2/5/2010
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D
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75000
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(2)
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8/20/2019
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Class A Common
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75000
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(2)
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0
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D
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Employee Stock Option (Right to Buy)
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$50.29
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2/5/2010
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D
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200000
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(2)
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8/15/2017
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Class A Common
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200000
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(3)
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0
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D
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Employee Stock Option (Right to Buy)
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$49.55
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2/5/2010
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D
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100000
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(3)
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12/9/2016
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Class A Common
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100000
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(3)
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0
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D
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Employee Stock Option (Right to Buy)
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$51.83
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2/5/2010
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D
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100000
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(3)
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6/13/2015
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Class A Common
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100000
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(3)
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0
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D
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Explanation of Responses:
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(
1)
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Disposed of pursuant to merger agreement amount issuer, Boulder Acquisition Corp and Xerox Corporation in exchange for $20,467.07 and 7,793 shares of Xerox common stock having a market value of $8.65 per share on the effective date of the merger.
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(
2)
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This opinion was assumed by Xerox in the merger and replaced with an option to purchase 7.085289 shares of Xerox common stock. At this time it has no purchase or sale price.
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(
3)
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This option was assumed Xerox in the merger and replaced with an option to purchase 7.085289 shares of Xerox common stock for exercise prices ranging from $6.32 to $7.32.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Burlin Tom
9763 HAWKINS CREAMERY ROAD
LAYTONSVILLE, MD 20882
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Executive Vice President
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Signatures
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/s/ Tom Burlin
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2/9/2010
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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