Jason Industries Form 4 Jason Industries / BRIAN KOBYLINSKI ownership change

SEC Form 4

FORM 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

KOBYLINSKI BRIAN

(Last) (First) (Middle)

833 EAST MICHIGAN STREET

SUITE 900

(Street)

MILWAUKEE WI 53202

(City) (State) (Zip)

2. Issuer Name and Ticker or Trading Symbol
Jason Industries, Inc. [ JASN ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
President & CEO

3. Date of Earliest Transaction (Month/Day/Year)
04/27/2018

4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
			Code	V	Amount	(A) or (D)	Price
Common Stock	04/27/2018		M		19,794	A	$2.78	149,588	D

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)		5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
				Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Restricted Stock Units	(1)	04/27/2018		M			19,794	(1)	(1)	Common Stock	19,794	$0	19,793	D
Restricted Stock Units	(2)							(2)	(2)	Common Stock	110,000		110,000	D
Restricted Stock Units	(3)							(3)	(3)	Common Stock	257,145		257,145	D
Restricted Stock Units(4)	(5)							(5)	(5)	Common Stock	360,000		360,000	D

Explanation of Responses:

1. The time-vesting restricted stock units vest in equal one-third (1/3) installments on each of the first three (3) anniversaries following April 27, 2016, provided that the reporting person has not been terminated prior to the applicable vesting date.

2. The cliff-vesting restricted stock units vest on the third anniversary of the applicable grant date, provided that the reporting person has not been terminated or the restricted stock units have not previously been forfeited prior to the vesting date.

3. The time-vesting restricted stock units vest in two equal installments with the first vesting date being January 5, 2019 and the second vesting date being July 5, 2020, provided that the reporting person has not been terminated prior to the applicable vesting date.

4. Subject to stockholder approval of amendments to the Company's 2014 Omnibus Incentive Plan at the Company's annual meeting to be held on May 16, 2018.

5. The time-vesting restricted stock units vest in equal one-third (1/3) installments on each of the first three (3) anniversaries following March 23, 2018, provided that the reporting person has not been terminated prior to the applicable vesting date.

Remarks:

	/s/ James M. Reeves as attorney-in-fact	04/30/2018
	** 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 4 (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.