SEC Form 4 · accession 0001179110-16-017743
Liberty Tax, Inc. · TAXA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
John T Hewitt
Officer — Chief Executive Officer/Pres. · Director · 10% Owner
Period of report
Jan 12, 2016
Accepted (ET)
Jan 14, 2016 · 5:32 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001528930
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class A Common Stock | Jan 12, 2016 | M | 21,749 | $15.00 | A | 1,007,500 | D | |
| Class A Common StockF1 | Jan 12, 2016 | F | 18,422 | $19.51 | D | 989,078 | D | |
| Class A Common Stock | Jan 13, 2016 | M | 7,961 | $15.00 | A | 997,039 | D | |
| Class A Common StockF2 | Jan 13, 2016 | F | 7,000 | $18.39 | D | 990,039 | D | |
| Class A Common Stock | Jan 14, 2016 | M | 9,932 | $15.00 | A | 999,971 | D | |
| Class A Common StockF3 | Jan 14, 2016 | F | 8,772 | $18.27 | D | 991,199 | D | |
| Class A Common StockF4 | holding | — | — | — | 141,553 | I | By 401(k) plan |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Options (Right to Buy) | $15.00 | Jan 12, 2016 | M | 21,749 | D | Apr 15, 2011 | Apr 15, 2016 | Class A Common Stock | 39,642 | 17,893 | D |
| Employee Stock Options (Right to Buy) | $15.00 | Jan 13, 2016 | M | 7,961 | D | Apr 15, 2011 | Apr 15, 2016 | Class A Common Stock | 17,893 | 9,932 | D |
| Employee Stock Options (Right to Buy) | $15.00 | Jan 14, 2016 | M | 9,932 | D | Apr 15, 2011 | Apr 15, 2016 | Class A Common Stock | 9,932 | 0 | D |
Explanation of responses
- F1Reflects 18,422 shares sold by a broker-dealer at an average market price of $19.51 per share less an exercise price of $15.00 per share to fund the exercise of 3,327 options owned by John T. Hewitt.
- F2Reflects 7,000 shares sold by a broker-dealer at an average market price of $18.39 per share less an exercise price of $15.00 per share to fund the exercise of 961 options owned by John T. Hewitt.
- F3Reflects 8,772 shares sold by a broker-dealer at an average market price of $18.27 per share less an exercise price of $15.00 per share to fund the exercise of 1,160 options owned by John T. Hewitt.
- F4Reflects shares of Class A Common Stock held through the Company 401(k) plan. The reporting person's holdings in the Company 401(k) plan have fluctuated since the filing of the original Form 3, and the reported holdings are based on the reporting person's 401(k) plan statement as of January 13, 2016.