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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 04/05/2022 | 3. Issuer Name and Ticker or Trading Symbol Quotient Technology Inc. [ QUOT ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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 | 78,314(1)(2) | D |
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) | 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 |
Explanation of Responses: |
1. Includes (i) a Restricted Stock Units (RSUs) award granted on August 1, 2020 with respect to 40,000 shares of common stock which vests as to 25% of the RSUs on April 1, 2021 and as to 6.25% of the RSUs every three (3) months thereafter; (ii) an RSU award granted on August 4, 2020 with respect to 14,000 shares of common stock which vests as to 6.25% of the RSUs on November 1, 2020 and every three (3) months thereafter; (iii) an RSU award granted on August 1, 2021 with respect to 25,000 shares of common stock which vests as to 6.25% of the RSUs on November 1, 2021 and every three (3) months thereafter; and (iv) an RSU award granted on March 1, 2022 with respect to 6,000 shares of common stock which vests as to 100% of the RSUs on December 31, 2022, (continued on next footnote) |
2. (continued from previous footnote) each of which is payable solely in common stock of the issuer and of which 10,436 shares in the aggregate were withheld by and surrendered to the Issuer to satisfy tax withholding obligations that arose in connection with vesting events, and (v) 3,750 shares acquired by the reporting person under the Issuer's Amended and Restated 2013 Employee Stock Purchase Plan, of which 1,250 shares were acquired on each of November 15, 2020, May 15, 2021, and November 15, 2021. |
Remarks: |
Exhibit 24 - Power of Attorney |
/s/ John Platz, Attorney-in-Fact for John P. Kellerman | 04/15/2022 | |
** 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. |