Statement of Changes in Beneficial Ownership (4)
November 05 2021 - 01:38PM
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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OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
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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
|
|
1. Name
and Address of Reporting Person * Goldenberg Spencer
E |
2. Issuer Name and Ticker or Trading
Symbol Stonemor Inc. [ STON ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
|
(Last)
(First)
(Middle)
C/O STONEMOR INC., 3331 STREET ROAD, SUITE 200 |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/4/2021
|
(Street)
BENSALEM, PA 19020
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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
|
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 |
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 |
Restricted Phantom Common
Stock |
(1) |
11/4/2021 |
|
A |
|
3875.969 |
|
(1) |
(1) |
Common Stock |
3875.969 (2) |
$2.58 (3) |
52338.7 (4) |
D |
|
Explanation of
Responses: |
(1) |
Each share of restricted
phantom common stock is the economic equivalent of one share of
common stock. Restricted phantom common stock becomes payable, in
cash or shares of common stock, at the election of the issuer, upon
the separation of the reporting person from service as a director
or upon the occurrence of certain other events specified in Section
409A of the Internal Revenue Code of 1986, as amended. |
(2) |
The reporting person
received these shares of restricted phantom common stock pursuant
to the StoneMor Amended and Restated 2019 Long-Term Incentive Plan
(as amended from time to time, the "Plan") in lieu of payment to
the reporting person of $10,000 which represents a portion of the
reporting person's annual director's retainer fee. |
(3) |
Reflects the closing price
of the issuer's common stock as reported by the New York Stock
Exchange on the trading day immediately preceding the date on which
the shares of restricted phantom common stock were
credited. |
(4) |
Represents shares of
restricted phantom common stock allocated to the reporting person's
deferred compensation account under the Plan. |
Remarks:
The filing of this statement shall not be construed as an admission
(a) that the person filing this statement is, for the purposes of
Section 16 of the Securities Exchange Act of 1934, as amended, the
beneficial owner of any equity securities covered by this
statement, or (b) that this statement is legally required to be
filed by such person. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Goldenberg Spencer E
C/O STONEMOR INC.
3331 STREET ROAD, SUITE 200
BENSALEM, PA 19020 |
X |
|
|
|
Signatures
|
/s/ Lauren N. Olson,
Attorney-in-Fact |
|
11/5/2021 |
**Signature of Reporting
Person |
Date |
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