SEC Form 4 · accession 0000899243-16-031722

Advanced Disposal Services, Inc. · ADSW

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).

Reporting owner

Steven R. Carn

Officer — CFO

Period of report

Oct 12, 2016

Accepted (ET)

Oct 14, 2016 · 5:35 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001585790

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I
Common Stock^F1	Oct 12, 2016	A	353,841	—	A	353,841	D
Common Stock^F2	Oct 12, 2016	A	55,556	—	A	409,397	D
Common Stock^F3	Oct 12, 2016	A	4,388	—	A	413,785	D

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Employee Stock Option (right to buy)^F5	$17.70	Oct 12, 2016	A	1,610	A	—	Apr 25, 2023	Common Stock	1,610	1,610	D
Employee Stock Option (right to buy)^F6	$13.00	Oct 12, 2016	A	61,097	A	—	Apr 26, 2022	Common Stock	61,097	61,097	D
Employee Stock Option (right to buy)^F7	$24.29	Oct 12, 2016	A	13,927	A	—	Jun 24, 2026	Common Stock	13,927	13,927	D
Employee Stock Option (right to buy)^F8	$18.00	Oct 12, 2016	A	84,603	A	—	Oct 12, 2026	Common Stock	84,603	84,603	D

Explanation of responses

F1These shares of the Issuer's common stock (the "Common Stock") were issued to the reporting person in exchange for shares of common stock of Advanced Disposal Waste Holdings Corp. ("Parent") that were cancelled and converted into shares of Common Stock of equivalent value in connection with the merger of Parent into the Issuer with the Issuer as the surviving corporation (the "Merger"). The Merger was exempt from the provisions of Section 16(b) of the Securities Exchange Act of 1934, as amended, pursuant to Rule 16b-7 thereunder.
F2Shares of Common Stock subject to a grant of restricted stock units made in connection with the Issuer's initial public offering. The award will vest in full on the third anniversary of the date of grant (the date of grant being 10/12/2016).
F3Shares of Common Stock subject to a grant of restricted stock units made to replace restrict stock units of equivalent value that covered common stock of Parent and were cancelled in connection with the Merger. The award will vest in three equal installments over each of the first three anniversaries of the date of grant (date of grant being 6/24/2016).
F4Option awards that were granted to replace options of equivalent intrinsic value that covered common stock of Parent and were cancelled in connection with the Merger.
F5The options vested in full, according to their terms, as of the closing of the Issuer's initial public offering.
F6The options vested in full, according to their terms, as of the closing of the Issuer's initial public offering.
F7The options will vest in three equal installments over each of the first three anniversaries of the date of grant (date of grant being 6/24/2016).
F8Award of options made in connection with the Issuer's initial public offering. The options will vest in full on the third anniversary of the date of grant (the date of grant being 10/12/2016).