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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Sepulveda Carlos M 12700 PARK CENTRAL DRIVE SUITE 1700 DALLAS, TX 75251 |
X | Executive Chairman |
/s/Adam D. Nelson Attorney-in-fact | 12/11/2015 | |
**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) | Shares were distributed to the reporting person as the ultimate recipient of a distribution made by Triumph Consolidated Cos., LLC, under the terms of its operating agreement. See Footnote 1 to "Security Ownership of Certain Beneficial Owners and Management" of Issuer's most recent proxy statement on Form 14-A filed with the Securities and Exchange Commission on March 27, 2015. |
(2) | Consists of (i) 306,830 shares beneficially owned by reporting person, (ii) 155,026 shares beneficially owned jointly with spouse Susan S Sepulveda, and (iii) 1,851 unvested shares of restricted common stock of Issuer granted to reporting person on 04/01/2015 of which 617 shares will vest on 04/01/2016, 617 shares will vest on 04/01/2017, and 617 shares will vest on 04/01/2018. |