NCS Multistage (NCSM) Form 3 NCS Multistage / Robert Nipper ownership change

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^*

Nipper Robert

(Last) (First) (Middle)

C/O NCS MULTISTAGE HOLDINGS, INC.

19450 STATE HIGHWAY 249, SUITE 200

(Street)

HOUSTON TX 70070

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
04/27/2017

3. Issuer Name and Ticker or Trading Symbol
NCS Multistage Holdings, Inc. [ NCSM ]

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

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

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)
Common Stock	185,250	D
Common Stock	1,771,926(1)	I	By Family Limited Partnership

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
Option (right to buy)	(2)	12/21/2022	Common Stock	165,549	5.88	D
Option (right to buy)	(3)	12/21/2022	Common Stock	248,322	5.88	D

Explanation of Responses:

1. These securities are held by the Nipper Family Limited Partnership, a limited partnership of which the reporting person is the trustee of the sole general partner, Nipper Family Management Trust. The reporting person disclaims beneficial ownership of the Issuer's securities held by the Nipper Family Limited Partnership except to the extent of his pecuniary interest therein.

2. Consists of 132,439 vested and exercisable options and 33,110 options that vest and become exercisable on December 21, 2017.

3. These options vest and become exercisable in three equal annual installments beginning on May 3, 2018.

Remarks:

See Exhibit 24.1 - Power of Attorney.

	/s/ Kevin Trautner, attorney-in-fact	04/27/2017
	** 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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