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
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person*
| C/O COMMSCOPE HOLDING COMPANY, INC. |
| 1100 COMMSCOPE PLACE SE |
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year)
02/07/2023
|
3. Issuer Name and Ticker or Trading Symbol
CommScope Holding Company, Inc.
[ COMM ]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| SVP & President, NICS |
|
5. If Amendment, Date of Original Filed
(Month/Day/Year)
|
6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
|
Form filed by More than One Reporting Person |
|
| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
|
3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
4. Nature of Indirect Beneficial Ownership (Instr.
5)
|
| Common Stock |
53,344
|
D |
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 1. Title of Derivative Security (Instr.
4)
|
2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
|
4. Conversion or Exercise Price of Derivative Security
|
5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
6. Nature of Indirect Beneficial Ownership (Instr.
5)
|
| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Stock Option (right to buy) |
03/01/2020
|
05/15/2029 |
Common Stock |
32,050 |
18.6 |
D |
|
| Explanation of Responses: |
|
|
| Remarks: |
|
|
/s/ Michael D. Coppin, under a Power of Attorney |
02/17/2023 |
|
** 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. |
SECTION 16
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby constitutes and
appoints Justin C. Choi
and Michael D. Coppin, or any of them, the undersigned's true and lawful
attorney-in-fact to:
(1) prepare, execute in the undersigned's name and on the undersigned's
behalf, and submit
to the U.S. Securities and Exchange Commission (the "SEC") a Form ID, including
amendments thereto,
and any other documents necessary or appropriate to obtain codes and passwords
enabling the
undersigned to make electronic filings with the SEC of reports required by
Section 16(a) of the Securities
Exchange Act of 1934 or any rule or regulation of the SEC;
(2) execute for and on behalf of the undersigned, in the undersigned's
capacity as an officer
and/or director of CommScope Holding Company, Inc. (the "Company"), Forms 3, 4,
and 5 in accordance
with Section 16(a) of the Securities Exchange Act of 1934 and the rules
thereunder;
(3) 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, or 5 and
timely file such form with
the SEC and any stock exchange or similar authority; and
(4) 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 Section 16 of the Securities Exchange Act of
1934.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer
required to file Forms 3, 4, and 5 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 affixing his or her signature to this
Power of Attorney, the
undersigned hereby revokes any and all previously executed Powers of Attorney
for the same or similar
purposes.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as
of this 9th day of February, 2023.
/s/ Bart Giordano
Bart Giordano
1
- 1 -
LEGAL02/34428498v1
