Statement of Changes in Beneficial Ownership (4)
August 03 2021 - 08:56AM
Edgar (US Regulatory)
FORM 4
[ ]
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 * KISZKA
ROBERT |
2. Issuer Name and Ticker or Trading
Symbol Smart Sand, Inc. [ SND ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Executive VP of Operations |
(Last)
(First)
(Middle)
C/O SMART SAND, INC., 1725 HUGHES LANDING BLVD, SUITE
800 |
3. Date of Earliest Transaction (MM/DD/YYYY)
7/30/2021
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(Street)
THE WOODLANDS, TX 77380
(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
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1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. 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 |
Common Stock |
7/30/2021 |
|
A |
|
70671 (1) |
A |
$0 |
288781 |
D |
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Common Stock |
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|
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|
|
|
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448738 |
I |
BY LLC (2) |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
Explanation of
Responses: |
(1) |
Represents shares of
Restricted Stock granted to the Reporting Person on July 30, 2021
under the Issuer's 2016 Long Term Incentive Award Plan, which vest
in four equal annual installments on each of the next four
anniversaries of the grant date, subject to the Reporting Person's
continued employment with or service to the Issuer through the
applicable vesting date. |
(2) |
Held by a limited liability
company ("LLC") of which the Reporting Person serves as the sole
member with sole voting and investment control over the securities
held thereby. The Reporting Person disclaims beneficial ownership
of the securities held by the LLC except to the extent of his
pecuniary interest therein. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
KISZKA ROBERT
C/O SMART SAND, INC.
1725 HUGHES LANDING BLVD, SUITE 800
THE WOODLANDS, TX 77380 |
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Executive VP of Operations |
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Signatures
|
/s/ Lee E. Beckelman, as Attorney-in-Fact for
Robert Kiszka |
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8/3/2021 |
**Signature of
Reporting Person |
Date |
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