SEC Form 4 · accession 0001562762-18-000097
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
Mar 14, 2018
Accepted (ET)
Mar 15, 2018 · 2:13 pm EDT
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 | Mar 14, 2018 | X | 21,235 | $1.24 | A | 568,494 | I | By Family Limited Partnership |
| Common StockF2,F1 | Mar 14, 2018 | S | 21,235 | $15.77 | D | 547,259 | I | By Family Limited Partnership |
| Common StockF3 | holding | — | — | — | 22,572 | D |
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)F3,F4 | $1.24 | Mar 14, 2018 | X | 21,235 | D | — | Jan 9, 2019 | Common Stock | 21,235 | 0 | I |
| Option (right to buy)F5 | $5.88 | holding | — | — | — | — | Dec 21, 2022 | Common Stock | 114,612 | 114,612 | 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.
- F2The price reported is a weighted average price. These shares were sold in multiple transactions at prices ranging from $15.51 to $16.50. 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 number of shares sold at each separate price within the ranges set forth in this footnote.
- F3Consists of 22,572 restricted stock units which vest in three equal annual installments beginning on March 1, 2019.
- F4These options have vested and are exercisable.
- F5Consists of 45,846 vested and exercisable options and 68,766 options that vest and become exercisable in three equal annual installments beginning on May 3, 2018.