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) 03/12/2018 | 3. Issuer Name and Ticker or Trading Symbol Civitas Solutions, Inc. [ CIVI ] | |||||||||||||
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 | 18,234(1) | 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 | ||||
Non-Qualified Stock Options | 09/16/2015 | 09/16/2025 | Non-Qualified Stock Options | 4,402 | 17 | D | |
Non-Qualified Stock Options | 12/03/2016 | 12/03/2026 | Non-Qualified Stock Options | 2,285(2) | 26 | D | |
Non-Qualified Stock Options | 12/06/2017 | 12/06/2027 | Non-Qualified Stock Options | 4,095(3) | 16.75 | D | |
Non-Qualified Stock Options | 03/09/2019 | 03/09/2029 | Non-Qualified Stock Options | 6,908(4) | 14.45 | D |
Explanation of Responses: |
1. Includes 288 restricted stock units that vest on December 3, 2018, 1,045 restricted stock units that vest in two equal installments on December 6, 2017 and December 6, 2018, 2,800 restricted stock units that will vest in two equal increments over a three-year period, with the first vesting date on March 1, 2019, 2,763 restricted stock units that will vest in three annual increments over a three-year period, with the first vesting date on December 8, 2018, and 5,450 restricted stock units that will vest in three equal annual increments over a three-year period, with the first vesting date on March 9, 2019. The restricted stock units are subject to the terms and conditions of the Civitas Solutions, Inc. 2014 Omnibus Incentive Plan. |
2. The stock options are subject to the terms and conditions of Civitas Solutions, Inc. 2014 Omnibus Plan. Includes 762 non-qualified stock options that will vest on December 3, 2018. |
3. The stock options are subject to the terms and conditions of Civitas Solutions, Inc. 2014 Omnibus Plan. Includes 2,730 non-qualified stock options that will vest in two equal installments on December 6, 2018 and December 6, 2019. |
4. The stock options are subject to the terms and conditions of the Civitas Solutions, Inc. 2014 Omnibus Incentive Plan, and vest in three equal annual increments over a three-year period, with the first vesting date on March 9, 2019. |
Remarks: |
/s/ Gina L. Martin, by power of attorney | 03/22/2018 | |
** 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. | ||
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. |