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)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/28/2023 |
3. Issuer Name and Ticker or Trading Symbol
Savers Value Village, Inc. [ SVV ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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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) |
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 | ||||
Option (Right to Purchase)(1) | (2) | 01/01/2030(2) | Common Stock | 82,678(2) | 1.41 | D | |
Option (Right to Purchase)(1) | (3) | 12/09/2030(3) | Common Stock | 17,838(3) | 3.16 | D |
Explanation of Responses: |
1. Options previously granted under the Registrant's 2019 Management Incentive Plan. Each option represents the right to receive upon exercise one share of the Registrant's common stock subject to the applicable vesting and settlement conditions. |
2. Approximately 40% represents time-based options with a vesting schedule in substantially equal annual installments over five years starting January 1, 2021, and approximately 60% represents performance-based options, of which 25% vested upon the initial public offering and the remainder will be eligible for vesting upon satisfaction of certain performance criteria including stock price performance. |
3. Approximately 40% represents time-based options with a vesting schedule in substantially equal annual installments over five years starting December 9, 2021, and approximately 60% represents performance-based options, of which 25% vested upon the initial public offering and the remainder will be eligible for vesting upon satisfaction of certain performance criteria including stock price performance. |
Remarks: |
Exhibit 24.1 - Power of Attorney |
/s/ Duane C. Woods | 06/28/2023 | |
** 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. |