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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1. Name and Address of Reporting Person*
JUSTYN TIMOTHY

(Last) (First) (Middle)
3560 BASSETT STREET

(Street)
SANTA CLARA CA 95054

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/20/2018
3. Issuer Name and Ticker or Trading Symbol
INTEVAC INC [ IVAC ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP & General Manager,
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 85,522 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
Non-Qualified Stock Option (right to buy) 02/27/2010(1) 02/27/2019 Common Stock 10,000 3.91 D
Non-Qualified Stock Option (right to buy) 05/09/2014(1) 05/09/2020 Common Stock 6,000 4.49 D
Non-Qualified Stock Option (right to buy) 05/19/2017(1) 05/19/2023 Common Stock 16,250 4.8 D
Non-Qualified Stock Option (right to buy) 05/21/2016(2) 05/21/2022 Common Stock 16,250 5.42 D
Non-Qualified Stock Option (right to buy) 08/06/2014(2) 08/06/2018 Common Stock 2,286 6.54 D
Non-Qualified Stock Option (right to buy) 05/15/2015(1) 05/15/2021 Common Stock 8,000 7.09 D
Non-Qualified Stock Option (right to buy) 06/21/2013(1) 06/21/2019 Common Stock 5,335 7.55 D
Non-Qualified Stock Option (right to buy) 08/21/2009(1) 08/21/2018 Common Stock 10,000 11.16 D
Non-Qualified Stock Option (right to buy) 05/19/2012(1) 05/19/2018 Common Stock 10,000 11.33 D
Non-Qualified Stock Option (right to buy) 05/20/2011(1) 05/20/2018 Common Stock 10,000 11.84 D
Non-Qualified Stock Option (right to buy) 05/18/2018(1) 05/18/2024 Common Stock 15,000 12.75 D
Explanation of Responses:
1. The option will vest and become exercisable in four equal installments upon the Reporting Person's completion of each year of service over the four-year period measured from the grant date.
2. The option will vest and become exercisable in three equal installments upon the Reporting Person's completion of each year of service over the three-year period measured from the grant date.
By: Kevin Soulsby For: Tim Justyn 03/01/2018
** 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.