SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
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| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
09/11/2013
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3. Issuer Name and Ticker or Trading Symbol
A. H. Belo Corp
[ AHC ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| Editor-Dallas Morning News |
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5. 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 Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Series A Common Stock |
15,082 |
D |
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| Series A Common Stock |
3,636 |
I |
By 401(k) Account
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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 Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
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Restricted Stock Units (Time-Based)
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Series A Common Stock |
1,934 |
0 |
D |
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Restricted Stock Units (Time-Based)
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Series A Common Stock |
3,000 |
0 |
D |
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Restricted Stock Units (Time-Based)
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Series A Common Stock |
4,716 |
0 |
D |
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| Employee Stock Options (Right to Buy) |
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12/05/2013 |
Series B Common Stock |
6,000 |
28 |
D |
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| Employee Stock Options (Right to Buy) |
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12/03/2014 |
Series B Common Stock |
5,000 |
25.26 |
D |
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| Employee Stock Options (Right to Buy) |
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12/09/2015 |
Series B Common Stock |
2,400 |
21.67 |
D |
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| Employee Stock Options (Right to Buy) |
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07/23/2018 |
Series B Common Stock |
16,820 |
6.6 |
D |
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| Employee Stock Options (Right to Buy) |
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12/03/2018 |
Series B Common Stock |
12,000 |
2.05 |
D |
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| Explanation of Responses: |
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| Remarks: |
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Christine E. Larkin, Attorney-in-Fact |
09/16/2013 |
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** 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
5
(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. |
rrd351196_397628.html
ROBERT MONG
LIMITED POWER OF ATTORNEY FOR
A. H. BELO CORPORATION
INSIDER REPORTING OBLIGATIONS
KNOW ALL BY THESE PRESENTS, that the undersigned hereby makes, constitutes
and appoints each of Daniel J. Blizzard, Christine E. Larkin, and Jean Anne Brown, each
acting individually, as the undersigned's true and lawful attorney-in-fact, 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 other similar forms) relating to the securities
of A. H. Belo Corporation, 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");
(2) seek or obtain, as the undersigned's representative and on the
undersigned's behalf, 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 each
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 each 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 Limited Power of Attorney authorizes, but does not require, each 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 any such attorney-in-fact on
behalf of the undersigned pursuant to this Limited 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 any of such attorneys-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 the undersigned for profit disgorgement
or other recovery under Section 16(b) of the Exchange Act; and
(4) this Limited 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.
The undersigned hereby gives and grants each of the foregoing attorneys-in-fact
full power and authority to do and perform each 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 each such attorney-in-fact of, for and on behalf of the undersigned, shall
lawfully do or cause to be done by virtue of this Limited Power of Attorney.
This Limited Power of Attorney shall remain in full force and effect until revoked
by the undersigned in a signed writing delivered or faxed to A. H. Belo Corporation,
508 Young Street, Dallas, Texas 75202, Attention: Legal Department (Fax 214/977-8285)
or until termination of the undersigned's Section 16 reporting obligations with
respect to Company securities, whichever first occurs.
As of the date of this document, each attorney-in-fact designated herein is an
employee of A. H. Belo Corporation. This Limited Power of Attorney shall be
automatically revoked as to any such attorney-in-fact upon the date that such
person ceases to be employed by A. H. Belo Corporation.
IN WITNESS WHEREOF, the undersigned has caused this Limited Power of
Attorney to be executed as of this 18th day of July, 2013.
/s/ ROBERT MONG
ROBERT MONG
STATE OF TEXAS )
)
COUNTY OF DALLAS )
On this 18th day of July, 2013, ROBERT MONG personally appeared
before me, and acknowledged that he executed the foregoing instrument for the
purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
/s/ JAN COOPER
Typed Named: JAN COOPER
Notary Public, State of Texas
My Commission Expires: 12/13/2014
(NOTARY SEAL)
