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*
(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) 09/13/2018 | ||||||||||||||||||||||||||
| 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 | 09/13/2018 | P | 600 | A | $11.74 | 104,968 | D | |||
| Class A Common Stock | 09/14/2018 | P | 2,800 | A | $11.64(1) | 107,768 | D | |||
| Class A Common Stock | 09/17/2018 | P | 220 | A | $11.48(2) | 107,988 | D | |||
| Class A Common Stock | 32,018(3) | D | ||||||||
| Class A Common Stock | 128,074(4) | 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 | (5) | (5) | (5) | Class A Common Stock(5) | (5) | 128,074 | D | ||||||||
| Explanation of Responses: |
| 1. This price reported in column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $11.60 to $11.70, inclusive. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the U.S. Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the price range set forth in this footnote 1 to this Form 4. |
| 2. This price reported in column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $11.30 to $11.50, inclusive. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the U.S. Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the price range set forth in this footnote 2 to this Form 4. |
| 3. These shares of Class A Common Stock were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on November 22, 2017, and will vest in equal installments annually over three years, provided that the Reporting Person remains in the service of the Issuer through the applicable vesting date. |
| 4. These shares of Class A Common Stock were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on November 22, 2017, and will vest in equal installments annually over three years upon the achievement by the Issuer of certain performance goals, provided that the Reporting Person remains in the service of the Issuer through the applicable vesting date. |
| 5. The phantom stock is economically equivalent to the Issuer's Class A Common Stock. These phantom stock were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on November 22, 2017, and will vest upon the achievement by the Issuer of certain performance goals and be settled in cash on such vesting date, provided that the Reporting Person remains in the service of the Issuer through such vesting date. |
| Remarks: |
| /s/ Tyrone Johnson | 09/17/2018 | |
| ** 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. | ||