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 |
| Estimated average burden |
| 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)
03/05/2019
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3. Issuer Name and Ticker or Trading Symbol
Fortune Brands Home & Security, Inc.
[ FBHS ]
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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) |
| President, Global Plumbing |
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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 |
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| 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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| Common Stock, Par Value $0.01 |
6,024
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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 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 |
| Options (Right to Buy) |
02/28/2019 |
02/26/2028 |
Common Stock |
8,834 |
63.51 |
D |
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| Explanation of Responses: |
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| Remarks: |
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/s/ Angela M. Pla, Attorney-in-Fact for Cheri M. Phyfer |
03/07/2019 |
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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. |
LIMITED POWER OF ATTORNEY
I, Cheri M. Phyfer, hereby constitute and appoint
ROBERT K. BIGGART and ANGELA M. PLA, with full
powers of substitution or revocation, to serve as
my Attorneys-In-Fact and Agents to exercise the
powers and discretions set forth below:
1. To execute on my behalf any and all Securities
and Exchange Commission ("SEC") (i) Forms 3, 4 and
5 in accordance with Section 16 of the Securities
Exchange Act of 1934, as amended (the "Exchange
Act"), and the rules thereunder, relating to the
disclosure of my beneficial ownership of securities
in Fortune Brands Home & Security, Inc. (the
"Company") and (ii) Forms 144 in accordance with the
Securities Act of 1933, as amended (the "Securities
Act"), and the rules thereunder, relating to my
transactions in the securities of the Company; and
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 3, 4, 5 or Form 144 and timely file such
form with the SEC and any stock exchange or
similar authority and take any other action of
any type whatsoever in connection with the
foregoing which, in the opinion of such
attorneys-in-fact, may be of benefit to, in
the best interest of, or legally required by,
the undersigned.
The undersigned hereby grants to each such
attorneys-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
attorneys-in-fact 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 Section 16 of the Securities Exchange Act
or Rule 144 of the Securities Act.
This Power of Attorney shall at all times be
binding with respect to all actions taken by
the attorneys-in-fact in accordance with the
terms of this Power of Attorney. The powers
granted by this Power of Attorney shall begin
on March 5, 2019 and shall continue in full
force and effect until the undersigned is no
longer required to file Section 16 Reports with
respect to the equity securities of the Company,
unless earlier revoked by the undersigned in a
signed writing delivered to the foregoing
attorneys-in-fact.
I, Cheri M. Phyfer, executed this Limited Power
of Attorney on this 5th day of March, 2019.
/s/Cheri M. Phyfer
