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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
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 Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Restricted Stock Units | (11) | 03/20/2017 | A | 9,000 | (12) | (12) | Common Stock | 9,000 | $ 0 | 9,000 | D | ||||
Deferred Stock Units | (13) | 03/20/2017 | A | 414,725 | (14) | (14) | Common Stock | 414,725 | $ 0 | 414,725 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
PRIM BILLY D 101 NORTH CHERRY STREET SUITE 501 WINSTON-SALEM, NC 27101 |
X | Chairman, CEO and President |
/s/ David J. Mills by power of attorney for Billy D. Prim | 03/22/2017 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Shares withheld to satisfy tax withholding requirements on the vesting of restricted stock units on March 10, 2017. |
(2) | These restricted stock units may only be settled in stock and vest immediately. |
(3) | Shares withheld to satisfy tax withholding requirements on the vesting of restricted stock units on March 20, 2017. |
(4) | Held by Mr. Prim's spouse. |
(5) | Held by Billy D. Prim Revocable Trust of which Mr. Prim is the sole trustee. |
(6) | Held by BD Prim, LLC of which Mr. Prim is the sole manager. |
(7) | Held by 2010 Irrevocable Trust fbo Sarcanda Westmoreland Bellisimo of which Mr. Prim is the sole trustee. |
(8) | Held by 2010 Irrevocable Trust fbo Anthony Gray Westmoreland of which Mr. Prim is the sole trustee. |
(9) | Held by 2010 Irrevocable Trust fbo Jager Gralyn Dean Bellisimo of which Mr. Prim is the sole trustee. |
(10) | Held by 2010 Irrevocable Trust fbo Joseph Alexander Bellisimo of which Mr. Prim is the sole trustee. |
(11) | Each restricted stock unit represents a contingent right to receive one share of common stock. |
(12) | These restricted stock units vest in equal annual installments on March 20 of 2018, 2019 and 2020. |
(13) | Each deferred stock unit has a value as of a given date equal to the fair market value of one share of Primo Water Corporation common stock. |
(14) | Represents deferred stock units granted on March 20, 2017 in connection with the achievement of the second adjusted EBITDA target under the Primo Water Corporation Amended and Restated Value Creation Plan. These deferred stock units are to be delivered in equal annual installments in January of each of 2018, 2019, 2020, 2021 and 2022. |