SEC Filing - Carriage Services, Inc.

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SEC FORM 3 SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Elliott Paul Donald

(Last)

(First)

(Middle)

5219 LAURELWOOD

(Street)

KINGWOOD

77345

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
08/01/2019

3. Issuer Name and Ticker or Trading Symbol
CARRIAGE SERVICES INC [ CSV ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director		10% Owner
	Officer (give title below)	X	Other (specify below)
Sr. VP and Regional Partner

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	24,500	D
Common Stock	6,029	I	Joint with spouse

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Performance Award	⁽¹⁾	12/31/2023	Common Stock	10,500	⁽¹⁾	D
Stock Options	⁽²⁾	02/14/2028	Common Stock	16,610	25.43	D
Stock Options	⁽³⁾	03/21/2027	Common Stock	38,600	26.54	D
Stock Options	⁽⁴⁾	02/23/2026	Common Stock	17,300	20.06	D
Stock Options	⁽⁵⁾	02/24/2022	Common Stock	38,000	22.58	D

Explanation of Responses:

1. Represents performance awards, payable in shares, granted under the Carriage Services, Inc. 2017 Omnibus Incentive Plan. The award will vest (if at all) on December 31, 2023 provided that certain criteria surrounding share price performance is achieved and the Reporting Person has remained continuously employed by Carriage through such date.

2. Stock Options granted pursuant to Carriage Services, Inc. 2017 Omnibus Plan of which 1/5 vested on 2/14/2019 and 1/5 will vest on 2/24/2020, 2/14/2021, 2/14/2022 and 2/14/2023. The options will expire on 2/14/2028.

3. Stock Options granted pursuant to the Carriage Services, Inc. Second Amended and Restated 2006 Long-Term Incentive Plan of which 1/5 shares vested on 3/21/2018 and 3/21/2019 and 1/5 shares will vest each year on 3/21/2020, 3/21/2021 and 3/21/2022. These stock options expire on 3/21/2027.

4. Stock Options granted pursuant to the Carriage Services, Inc. Second Amended and Restated 2006 Long-Term Incentive Plan of which 1/5 shares vested on 2/23/2017, 2/23/2018 and 2/23/2019 and 1/5 shares will vest each year on 2/23/2020 and 2/23/2021. These stock options expire on 2/23/2026.

5. Stock Option grant pursuant to the Carriage Services, Inc. Second Amended and Restated 2006 Long-Term Incentive Plan of which 1/3 shares vested on 2/24/2016, 2/24/2017 and 2/24/2018. These stock options expire on 02/24/2022.

Remarks:

	/s/ Paul D. Elliott	08/08/2019
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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