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*
Dvorkin Viktar

(Last) (First) (Middle)
C/O EPAM SYSTEMS, INC.
41 UNIVERSITY DRIVE, SUITE 202

(Street)
NEWTOWN PA 18940

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/13/2018
3. Issuer Name and Ticker or Trading Symbol
EPAM Systems, Inc. [ EPAM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
SVP/Head of Global Delivery
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)
EPAM Common Stock 16,055(1) 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
Employee Stock Option (right to buy) (2) 03/19/2022 EPAM Common Stock 11,200 16.8 D
Employee Stock Option (right to buy) (3) 05/24/2023 EPAM Common Stock 16,000 23.04 D
Employee Stock Option (right to buy) (4) 03/31/2024 EPAM Common Stock 20,000 32.08 D
Employee Stock Option (right to buy) (5) 03/23/2025 EPAM Common Stock 18,000 61.38 D
Employee Stock Option (right to buy) (6) 03/25/2026 EPAM Common Stock 13,333 70.52 D
Employee Stock Option (right to buy) (7) 03/24/2027 EPAM Common Stock 12,868 73.27 D
Explanation of Responses:
1. Represents restricted stock units that are scheduled to vest on the following schedule. (A) 4000 that vested as to 25% of the shares on each of March 31, 2015, 2016, 2017, and will vest as to 25% of the shares on March 31, 2018; (B) 4000 that vested as to 25% of the shares on each of March 23, 2016 and 2017 and are scheduled to vest as to 25% of the shares on March 23, 2018 and 2019; (C) 4,799 that vested as to 25% of the shares on March 25, 2017 and are scheduled to vest as to 25% of the shares on each of March 25, 2018, 2019, and 2020; and (D) 4,514 shares that are scheduled to vest as to 25% of the shares on each of March 24, 2018, 2019, 2020 and 2021.
2. The option, representing a right to purchase a total of 11,200 shares, became exercisable as to 25% of the shares on each of March 19, 2013, 2014, 2015 and 2016.
3. The option, representing a right to purchase a total of 16,000 shares, became exercisable as to 25% of the shares on March 19, 2014, 2015, 2016 and 2017.
4. The option, representing a right to purchase 20,000 shares, became exercisable as to 25% of the shares on March 31, 2015, 2016 and 2017, and will become exercisable as to 25% of the shares on March 31,2018.
5. The option, representing a right to purchase a total of 18,000 shares, became exercisable as to 25% of the shares on each of March 23, 2016 and 2017, and will become exercisable as to 25% of the shares on each of March 23, 2018 and 2019.
6. The option, representing the right to purchase a total of 13,333 shares, became exercisable as to 25% of the shares on March 25, 2017, and will become exercisable as to 25% of the shares on each of March 25, 2018, 2019, and 2020.
7. The option, representing a right to purchase 12,868 shares, will become exercisable as to 25% of the shares on each of March 24, 2018, 2019, 2020 and 2021.
Remarks:
Ginger L. Mosier, as Attorney In Fact 02/22/2018
** 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.
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