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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Deferred Stock Units | (3) | 01/10/2018 | M | 28,982 | (4) | (4) | Common Stock | 28,982 | $ 0 | 86,946 | D | ||||
Deferred Stock Units | (3) | 01/10/2018 | M | 66,551 | (5) | (5) | Common Stock | 66,551 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Mills David J 101 NORTH CHERRY STREET SUITE 501 WINSTON-SALEM, NC 27101 |
Vice President Finance |
/s/ David J. Mills | 01/12/2018 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Represents shares of common stock received upon vesting of deferred stock units on January 10, 2018. |
(2) | Shares withheld to satisfy tax withholding requirements on the vesting of deferred stock units on January 10, 2018. |
(3) | Each deferred stock unit has a value as of a given date equal to the fair market value of one share of Primo Water Corporation common stock. |
(4) | 28,982 deferred stock units were delivered on January 10, 2018. The remaining 86,946 deferred stock units are to be delivered in equal annual installments in January of each of 2019, 2020 and 2021. |
(5) | 66,551 deferred stock units were delivered on January 10, 2018. |