Statement of Changes in Beneficial Ownership (4)
October 22 2021 - 7:08PM
Edgar (US Regulatory)
FORM 4
[X]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Brown Lance |
2. Issuer Name and Ticker or Trading Symbol
Select Interior Concepts, Inc.
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SIC
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Chief Accounting Officer |
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(Last)
(First)
(Middle)
400 GALLERIA PARKWAY, SUITE 1760 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
10/21/2021 |
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(Street)
ATLANTA, GA 30339
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Class A Common Stock | 10/21/2021 | | D | | 43469 (1) | D | $14.50 (2) | 0 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
| Restricted Sock Units | (3) | 10/21/2021 | | D | | | 27250 | (3) | (3) | Common Stock | 27250 | $14.50 (2) | 0 | D | |
| Explanation of Responses: |
| (1) | Includes time-vesting restricted stock units (RSUs) convertible into shares of Class A Common Stock. |
| (2) | Disposed of pursuant to merger agreement between issuer and Astro Stone Intermediate holding, LLC in exchange for a cash payment equal to the per share merger consideration ($14.50). |
| (3) | Reflects performance-based RSUs that each represented a contingent right to receive one share of Class A Common Stock based on the closing price of the Issuer's common stock exceeding specific hurdles for 20 consecutive trading days, and subject to the reporting person's continued employment with the Issuer. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Brown Lance
400 GALLERIA PARKWAY, SUITE 1760
ATLANTA, GA 30339 |
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| Chief Accounting Officer |
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Signatures
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| /s/ Scott Jarvis, attorney-in-fact | | 10/22/2021 |
| **Signature of Reporting Person | Date |
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