Initial Statement of Beneficial Ownership (3)
May 29 2015 - 4:18PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
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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
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Brink Carl Benjamin
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/21/2015
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3. Issuer Name
and
Ticker or Trading Symbol
CARRIAGE SERVICES INC [CSV]
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(Last)
(First)
(Middle)
28634 PLEASANT FOREST DRIVE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Principal Financial Officer /
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(Street)
KATY, TX 77494
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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3799
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Options
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(1)
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5/22/2018
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Common Stock
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10000.0
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$16.73
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D
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Stock Options
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(2)
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2/25/2019
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Common Stock
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12000.0
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$20.26
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D
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Stock Options
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(3)
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2/24/2022
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Common Stock
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22000.0
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$22.58
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D
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Explanation of Responses:
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(
1)
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Stock Option Grant pursuant to the Carriage Services, Inc. Amended and Restated 2006 Long-Term Incentive Plan of 15,000 options on 5/22/2013, of which 5,000 options vested on 5/22/2014 and were exercised on 3/26/2015, 5,000 options vested and became exercisable on 5/22/2015 and 5,000 options that vest on 5/22/2016. The options expire on 5/22/2018.
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(
2)
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Stock Option Grant pursuant to the Carriage Services, Inc. Amended and Restated 2006 Long-Term Incentive Plan of 18,000 options on 02/25/2014, of which 6,000 options vested on 02/25/2015 and were exercised on 3/26/2015, 6,000 options vest on 02/25/2016 and 6,000 options that vest on 02/25/2017. The options expire on 02/25/2019.
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(
3)
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Stock Option grant pursuant to the Carriage Services, Inc. Amended and Restated 2006 Long-Term Incentive Plan which vest 1/3 on 2/24/2016, 1/3 on 2/24/2017 and 1/3 on 2/25/2018. These stock options expire on 02/24/2022.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Brink Carl Benjamin
28634 PLEASANT FOREST DRIVE
KATY, TX 77494
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Principal Financial Officer
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Signatures
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/s/ Carl B. Brink
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5/29/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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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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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 control number.
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