| 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*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Select Interior Concepts, Inc. [ SIC ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 03/04/2019 | ||||||||||||||||||||||||||
| 4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 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 | ||||||
| Class A Common Stock | 03/04/2019 | D | 76,844(1) | D | $0.00 | 173,465(2) | D | |||
| Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 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 | ||||||||
| Phantom Stock | (3) | 03/04/2019 | D | 76,844 | (3) | (3) | Class A Common Stock(3) | (3) | (3) | 0 | D | ||||
| Restricted Stock Units | (4) | 03/04/2019 | A | 24,222 | (4) | (4) | Class A Common Stock(4) | 24,222 | $0.00 | 24,222 | D | ||||
| Explanation of Responses: |
| 1. These shares of Class A Common Stock, which were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on November 22, 2017, were forfeited on March 4, 2019 due to the non-achievement of certain performance goals of the Issuer. |
| 2. 19,211 shares of the Class A Common Stock held by the Reporting Person were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on November 22, 2017, and are subject to vesting over three years in nearly equal annual installments beginning on the first anniversary of the grant date, provided that the Reporting Person remains in the service of the Issuer through the applicable vesting date. |
| 3. The phantom stock, which were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on November 22, 2017, were forfeited on March 4, 2019 due to the non-achievement of certain performance goals of the Issuer. |
| 4. These restricted stock units were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on March 4, 2019, and are subject to vesting over three years in nearly equal annual installments beginning on the first anniversary of the grant date, provided that the Reporting Person remains in the service of the Issuer through the applicable vesting date. Each restricted stock unit represents a contingent right to receive one share of the Issuer's Class A Common Stock. |
| Remarks: |
| /s/ Tyrone Johnson, attorney-in-fact | 03/06/2019 | |
| ** 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. | ||
