Statement of Changes in Beneficial Ownership (4)
December 14 2021 - 1:37PM
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
*
Yost Mark J. |
2. Issuer Name and Ticker or Trading Symbol
Skyline Champion Corp
[
SKY
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) CEO & President |
(Last)
(First)
(Middle)
C/O SKYLINE CHAMPION CORPORATION, 755 W. BIG BEAVER RD., SUITE 1000 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/13/2021 |
(Street)
TROY, MI 48084
(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 | 12/13/2021 | | G(1) | | 144000 | D | $0.00 | 126985 | D | |
Common Stock | 12/13/2021 | | G(1) | | 144000 | A | $0.00 | 144000 | I | As Investment Manager of a SLAT |
Common Stock | | | | | | | | 66466 (2) | I | As spouse to account holder |
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 |
Explanation of Responses: |
(1) | Represents a bona fide gift of shares as a contribution to an irrevocable Spousal Lifetime Access Trust by Reporting Person, over which Reporting Person retains sole investment authority. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer or the staff of the Securities and Exchange Commission, upon request, full information regarding the nature of the bona fide gift and the Trust to which the shares were contributed. |
(2) | Since the date of the last ownership form of the Reporting Person, 66,466 shares have been transferred and are now indirectly held by the Reporting Person in an account in the name of the Reporting Person's spouse. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Yost Mark J. C/O SKYLINE CHAMPION CORPORATION 755 W. BIG BEAVER RD., SUITE 1000 TROY, MI 48084 | X |
| CEO & President |
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Signatures
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/s/ Caren A. Ries, Attorney-in-Fact | | 12/14/2021 |
**Signature of Reporting Person | Date |
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