3: Initial statement of beneficial ownership of securities
Published on April 22, 2015
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Class A OP Units (1) (2) | (1)(2) | (3) | Common shares of beneficial interest, $0.01 par value | 19,600 | $ (1) (2) | D |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Palazzo Dominic M 7734 S GRAPE CT CENTENNIAL, CO 80122 |
X |
Signatures
Dominic M. Palazzo, by Jason Parsont, his Attorney-in-fact | 04/22/2015 | |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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). |
(1) | One year after the date of the completion of the initial public offering of the Issuer, the Reporting Person will have the right to cause NSA OP, LP (the "Partnership") to redeem all or a portion of the Reporting Person's Class A common units of limited partner interest in the Partnership ("Class A OP Units") for cash in an amount equal to the market value of an equivalent number of the Issuer's common shares, or at the Issuer's option, common shares on a one-for-one basis, subject to certain adjustments. The Class A OP Units in this table include 7,600 Class A OP Units issuable upon the conversion of 7,600 vested long-term incentive plan units in the Partnership ("LTIP units") and 12,000 Class A OP Units issuable upon conversion of 12,000 unvested LTIP units. |
(2) | The unvested LTIP units were granted to the Reporting Person under the Issuer's 2013 Long-Term Incentive Plan, and vest along a schedule at certain times prior to December 31, 2017, upon the achievement of certain performance goals, or upon the completion of the Issuer's initial public offering. |
(3) | N/A |
Remarks: Exhibit No. 24.1 Power of Attorney dated April 7, 2015. |