| FORM 4 | UNITED STATES SECURITIES AND
EXCHANGE COMMISSION Washington, D.C. 20549 |
OMB APPROVAL | ||||||||||||||||||||||
| STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP | ||||||||||||||||||||||||
| o Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
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 |
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| 1. Name and Address of Reporting Person* | 2. | Issuer Name and Ticker | 4. | Statement for | 6. | Relationship of Reporting Person(s) to Issuer | ||||||||||||||||||
| or Trading Symbol | (Month/Year) | (Check all applicable) | ||||||||||||||||||||||
| Szeftel, Ivan M. | Alliance Data Systems Corporation ADS | September 2001 | ___X___ Director ______ 10% Owner _______ Officer ______ Other |
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| (Last) | (First) | (Middle) | Officer/Other Description Executive Vice President | |||||||||||||||||||||
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17655 Waterview Parkway |
3. | I.R.S. Identification Number of Reporting Person, if an entity (voluntary) | 5. | If Amendment, Date of Original (Month/Year) |
7. | Individual or Joint/Group Filing (Check Applicable Line) |
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__ Form filed by More than
One Reporting Person X Form filed by One Reporting Person |
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| (Street) | ||||||||||||||||||||||||
| Dallas, TX 75252-8012 | ||||||||||||||||||||||||
| (City) | (State) | (Zip) | ||||||||||||||||||||||
| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||||||||||||||||
| 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 of (D) Of (Instr. 3, 4 and 5) |
5. | Amount of Securities
Beneficially Owned at End of Month (Instr. 3 and 4) |
6. | Ownership Form: Direct (D) or Indirect (I) (Instr. 4) |
7. | Nature of Indirect Beneficial Ownership (Instr. 4) |
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| Code | V | Amount | A/ D | Price | |||||||||||||||||||||||
| Common | 9/26/2001 | J | | 1,000(1) | A | $14.65 | 36,000 (2) | D | |||||||||||||||||||
| 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). | ||||||||||||||||||||||||
| Table II -
Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) |
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| 1. | Title of Derivative Security (Instr. 3) |
2. | Conversion or Exercise Price of Derivative Security |
3. | Transaction Date (Month/Day/ Year) |
4. | Transaction Code and Voluntary (V) Code (Instr. 8) |
5. | Number of Derivative Securities Acquired (A) or isposed (D) Of (Instr. 3, 4 and 5) |
6. | Date Exercisable(DE) and Expiration Date(ED) (Month/Day/Year) |
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| Code V | (A) | (D) | Date Exercisable |
Expiration Date |
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| Employee Stock Option (right to buy) | $9.00 | Varies (3) 07/24/2008 | |||||||||||||
| Employee Stock Option (right to buy) | $9.90 | Varies (4) 05/06/2009 | |||||||||||||
| Employee Stock Option (right to buy) | $15.00 | Varies (5) 08/31/2010 | |||||||||||||
| Employee Stock Option (right to buy) | $12.00 | Varies (6) 06/08/2011 | |||||||||||||
| 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. | Ownership Form of Derivative Security: Direct (D) or Indirect (I) |
11. | Nature of Indirect Beneficial Ownership (Instr. 4) |
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| Common 111,111 | 111,111 | D | ||||||||||||
| Common 22,222 | 22,222 | D | ||||||||||||
| Common 80,000 | 80,000 | D | ||||||||||||
| Common 38,048 | 38,048 | D | ||||||||||||
| Explanation of Responses: See attached statement |
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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). |
/s/ Kellie J. Watts
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| ** Signature of Reporting Person | Date | |||||||||||||
| Attorney-in-Fact for Ivan M. Szeftel |
9/26/2001 | |||||||||||||
| Note: | 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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| 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. | ||||||||||||||
Alliance Data Systems Corporation ADS
| Form 4 - September 2001 | ||
| Szeftel, Ivan M. 17655 Waterview Parkway Dallas, TX 75252-8012 |
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| Explanation of responses: | ||
| (1) | Purchase pursuant to SEC Release No. 44791 dated September 14, 2001, and extended with Release No. 44827 dated September 21, 2001. | |
| (2) | Total beneficial onwership includes 28,000 unvested shares of common stock pursuant to a restricted stock grant. | |
| (3) | The option is exercisable for 27,778 shares on each of 1/31/99 and 1/31/00 and 1/31/01, and for 27,777 shares on 1/31/02. | |
| (4) | The option is exercisable for 5,555 shares on 1/31/00, 5,556 shares on 1/31/01, 5,555 shares on 1/31/02, and 5,556 shares on 1/31/03. | |
| (5) | The option is exercisable for 26,400 shares on each of 8/31/01, and 8/31/02, and for 27,200 shares on 8/31/03. | |
| (6) | The option is exercisable for 33% of the underlying shares on each of 6/7/02 and 6/7/03, and for 34% on 6/7/04. | |