[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [X]Form 3 Holdings Reported [ ]Form 4 Transactions Reported |
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: 3235-0362 Expires: December 31, 2001 Estimated average burden hours per response. . . . . 0.5 |
1. Name and Address of Reporting Person* Tucker, Dwayne H. |
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) December 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 Executive Vice President, Chief Administrative Officer 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 (Instr. 8) |
4. Securities Acquired (A) or Disposed (D) Of (Instr. 3, 4, and 5) |
5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 3 and 4) |
6. Owner- ship Form: Direct(D) or Indirect (I) (Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Common | |
36,165 (1) | ||||
If the form is filed by more than one reporting person, see instruction 4(b)(v). (over) |
Tucker, Dwayne H. - December 2001 |
Form 5 (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 |
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 Year (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) |
$9.90 | |
Common - 27,777 | |
27,777 | |||||
Employee Stock Option (right to buy) |
$15.00 | |
Common - 115,000 | |
115,000 | |||||
Employee Stock Option (right to buy) |
$12.00 | |
Common - 81,917 | |
81,917 | |||||
** 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 Dwayne H. Tucker Page 2 |