0001062993-22-003790.txt : 20220211
0001062993-22-003790.hdr.sgml : 20220211
20220211161929
ACCESSION NUMBER: 0001062993-22-003790
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20211231
FILED AS OF DATE: 20220211
DATE AS OF CHANGE: 20220211
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Motes Joseph L III
CENTRAL INDEX KEY: 0001648042
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-15749
FILM NUMBER: 22621294
MAIL ADDRESS:
STREET 1: 7500 DALLAS PARKWAY, SUITE 700
CITY: PLANO
STATE: TX
ZIP: 75024
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: ALLIANCE DATA SYSTEMS CORP
CENTRAL INDEX KEY: 0001101215
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389]
IRS NUMBER: 311429215
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 3095 LOYALTY CIRCLE
CITY: COLUMBUS
STATE: OH
ZIP: 43219
BUSINESS PHONE: 6147294000
MAIL ADDRESS:
STREET 1: 3095 LOYALTY CIRCLE
CITY: COLUMBUS
STATE: OH
ZIP: 43219
5
1
form5.xml
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
X0306
5
2021-12-31
0
0
0001101215
ALLIANCE DATA SYSTEMS CORP
ADS
0001648042
Motes Joseph L III
7500 DALLAS PARKWAY, SUITE 700
PLANO
TX
75024
0
1
0
0
EVP, CAO, Gen Counsel & Secy
Common Stock
45116
D
In connection with the spin-off of Loyalty Ventures Inc. by the Issuer, outstanding unvested restricted stock units ("RSUs"), including RSUs previously granted to the Reporting Person, were subject to anti-dilution adjustments ("Anti-Dilution Adjustment"). To the extent that the outstanding RSUs granted to the Reporting Person were previously reported under Table I, the total number of shares reported include the additional RSUs held by the Reporting Person as a result of the Anti-Dilution Adjustment.
The total number of securities beneficially owned includes: (a) 5,604 unrestricted shares; (b) 288 unvested units from an award of 768 (adjusted from 728) time-based restricted stock units granted 2/15/19; (c) 1,431 unvested units from an award of 2,037 (adjusted from 1,839) time-based restricted stock units granted 2/18/20; (d) 4,804 (adjusted from 4,138) unvested performance-based restricted stock units granted 2/18/20; (e) 715 unvested units from an award of 1,018 (adjusted from 919) performance-based restricted stock units granted 2/18/20; (f) 21,934 (adjusted from 18,896) unvested time-based restricted stock units granted 2/16/21; and (g) 10,340 (adjusted from 8,908) unvested performance-based restricted stock units granted 2/16/21.
Benjamin L. Morgan, Attorney in Fact
2022-02-11
EX-24
2
exhibit24.txt
REVOCATION AND APPOINTMENT OF POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby revokes and rescinds
the Power of Attorney dated July 27, 2015, which appointed Cynthia L.
Hageman and Kristen Rafael-Githens as attorneys-in-fact, for purposes of
completing, executing and filing any applicable Forms 3, 4, 5 or 144 as
further set out in that Power of Attorney.
Know all by these presents, that the undersigned hereby constitutes and
appoints Tracy A. Crum, Cynthia L. Hageman and Benjamin L. Morgan as
the undersigned's true and lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned, in the undersigned's
capacity as an officer and/or director of Alliance Data Systems Corporation
(the "Company"), any filing in connection with the undersigned's holdings
of or transactions in securities issued by the Company, including but not
limited to, Forms 3, 4 or 5 in accordance with Section 16(a) of the
Securities Exchange Act of 1934, as amended, and the rules thereunder, or
Form 144 in accordance with Rule 144 of the Securities Act of 1933, as
amended, and the rules thereunder;
(2) do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any such Form,
including but not limited to, Forms 3, 4, 5 or 144, and timely file such
form with the United States Securities and Exchange Commission and any
stock exchange or similar authority; and
(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit
to, in the best interest of, or legally required by, the undersigned, it
being understood that the documents executed by such attorney-in-fact on
behalf of the undersigned pursuant to this power of attorney shall be in
such form and shall contain such terms and conditions as such
attorney-in-fact may approve in such attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and
powers herein granted, as fully to all intents and purposes as the
undersigned might or could do if personally present, with full power of
substitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or such attorney-in-fact's substitute or substitutes,
shall lawfully do or cause to be done by virtue of this power of attorney
and the rights and powers herein granted. The undersigned acknowledges
that the foregoing attorneys-in-fact, in serving in such capacity at the
request of the undersigned, are not assuming, nor is the Company assuming,
any of the undersigned's responsibilities to comply with the Securities
Exchange Act of 1934, as amended, or the Securities Act of 1933, as amended.
This power of attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, 5, or 144, or any
other form with respect to the undersigned's holdings of and transactions
in securities issued by the Company, unless earlier revoked by the
undersigned in a signed writing delivered to the foregoing
attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this power of attorney
to be executed as of this 2nd day of September, 2021.
/s/ Joseph L. Motes III
Printed Name: Joseph L. Motes III