Statement of Changes in Beneficial Ownership (4)
February 25 2022 - 6:06PM
Edgar (US Regulatory)
FORM 4
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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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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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Quezada Carlos R. |
2. Issuer Name and Ticker or Trading Symbol
CARRIAGE SERVICES INC
[
CSV
]
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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) EVP & Chief Operating Officer |
(Last)
(First)
(Middle)
3040 POST OAK BLVD., SUITE 300 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
2/23/2022 |
(Street)
HOUSTON, TX 77056
(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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Common Stock | | | | | | | | 5230 | 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 |
Stock Options | $49.48 | 2/23/2022 | | A | | 50000 | | (1) | 2/23/2032 | Common Stock | 50000.0 | (1) | 50000 | D | |
Performance Award | (2) | | | | | | | (2) | 12/31/2024 | Common Stock | 56190.0 | | 56190 | D | |
Stock Options | $34.79 | | | | | | | (3) | 2/17/2031 | Common Stock | 50000.0 | | 50000 | D | |
Stock Options | $18.02 | | | | | | | (4) | 6/25/2030 | Common Stock | 13333.0 | | 13333 | D | |
Explanation of Responses: |
(1) | Stock Options granted on 2/23/2022 pursuant to the Carriage Services, Inc. 2017 Omnibus Incentive Plan that will vest in equal increments each year over the next seven years. These options expire on 2/23/2032. |
(2) | Pursuant to the 2017 Omnibus Plan, the target share awards for the eligible employee will vest on December 31, 2024 if the Company's common stock reaches one of five pre-determined growth targets for a sustained period beginning on the grant date of June 25, 2020 and ending on December 31, 2024. |
(3) | Stock Options granted on 2/17/2021 pursuant to the Carriage Services, Inc. 2017 Omnibus Incentive Plan which vested 20% on 2/17/2022 and will vest in equal 20% increments each year over the next four years. These options expire on 2/17/2031. |
(4) | Stock Options granted pursuant to the Carriage Services, Inc. 2017 Omnibus Plan of which 1/3 vested on 6/25/2021 and 1/3 will vest each year on 6/25/2022 and 6/25/2023. 6,667 options were exercised on 9/1/2021. The options expire on 6/25/2030. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Quezada Carlos R. 3040 POST OAK BLVD. SUITE 300 HOUSTON, TX 77056 |
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| EVP & Chief Operating Officer |
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Signatures
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/s/ Carlos Quezada | | 2/25/2022 |
**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 control number. |
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