SEC Form 4 · accession 0001562762-18-000025
NCS Multistage Holdings, Inc. · NCSM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Tim Willems
Officer — Chief Operations Officer
Period of report
Feb 7, 2018
Accepted (ET)
Feb 9, 2018 · 6:01 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001692427
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Feb 7, 2018 | X | 70,000 | $1.24 | A | 519,259 | I | By Family Limited Partnership |
| Common StockF1 | Feb 9, 2018 | X | 28,000 | $1.24 | A | 547,259 | I | By Family Limited Partnership |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Option (right to buy)F1,F2 | $1.24 | Feb 7, 2018 | X | 70,000 | D | — | Jan 9, 2019 | Common Stock | 70,000 | 49,235 | I |
| Option (right to buy)F1,F2 | $1.24 | Feb 9, 2018 | X | 28,000 | D | — | Jan 9, 2019 | Common Stock | 28,000 | 21,235 | I |
| Option (right to buy)F2 | $5.88 | holding | — | — | — | — | Dec 21, 2022 | Common Stock | 45,846 | 45,846 | D |
| Option (right to buy)F3 | $5.88 | holding | — | — | — | — | Dec 21, 2022 | Common Stock | 68,766 | 68,766 | D |
Explanation of responses
- F1These securities are held by the Willems Family Limited Partnership, a limited partnership of which the reporting person and his spouse are co-trustees of the sole general partner, Willems Family Management Trust. The reporting person disclaims beneficial ownership of the Issuer's securities held by the Willems Family Limited Partnership except to the extent of his pecuniary interest therein.
- F2These options have vested and are exercisable.
- F3These options vest and become exercisable in three equal annual installments beginning on May 3, 2018.