4: Statement of changes in beneficial ownership of securities
Published on September 8, 2015
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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 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) |
(e.g., puts, calls, warrants, options, convertible securities)
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 | ||||||||
Class A OP Units (1) | (1) | 09/03/2015 | P | 35,460 (2) | (1) | (3) | Common shares of beneficial interest, $0.01 par value | 35,460.00 (1) (2) | $ 12.71 | 4,126,149 (4) | I | See Footnote (2) | |||
Class B OP Units, Series NW (5) | (1) (5) (6) | 09/03/2015 | P | 35,461 (7) | (1)(5) | (3) | Class A OP Units (7) | (5) (6) (7) | (5) (6) | 1,638,142 (8) | I | See Footnote (7) |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Howard Kevin Maxen 14855 SE 82ND DRIVE CLACKAMAS, OR 97015 |
X | X |
Signatures
Kevin Maxen Howard, by Jason Parsont, his Attorney-in-fact | 09/08/2015 | |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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) | One year after the closing of the contribution agreement, the Reporting Person will have the right to cause the Partnership to redeem all or a portion of the Reporting Person's Class A common units of limited partner interest (the "Class A OP Units") of NSA OP, LP (the "Partnership"), reported in this Form 4, for cash in an amount equal to the market value of an equivalent number of the Issuer's common shares of beneficial interest, or at the Issuer's option, common shares of beneficial interest on a one-for-one basis, subject to certain adjustments. |
(2) | Consists of the Reporting Person's pecuniary interest in 35,460 Class A OP Units in the Partnership held by Hillsboro RV/Boat Storage, LLC ("Hillsboro"), for which the Reporting Person has or shares voting and investment power. |
(3) | N/A |
(4) | The Reporting Person's total direct and indirect beneficial ownership of Class A OP Units following the reported transaction above is 4,126,149 Class A OP Units, which includes those Class A OP Units reported on Form 3 on April 22, 2015 (the "Form 3"), the Class A OP Units reported on Form 4 on August 12, 2015 and the Class A OP Units reported herein (together with those securities convertible into, or exchangeable for, such Class A OP Units as specified in the Form 3). The 4,126,149 Class A OP Units do not include derivative securities of other classes of the Reporting Person that were reported on the Form 3 or the non-derivative securities that were reported on the Forms 4 on April 30, 2015 and August 18, 2015, respectively. |
(5) | Two years after the date of the completion of the initial public offering of the Issuer, the Class B common units of limited partner interest (the "Class B OP Units") of the Partnership will be convertible into Class A OP Units of the Partnership (i) at the Reporting Person's election only upon the achievement of certain performance thresholds relating to the properties to which such Class B OP Units relate (a "Voluntary Conversion") or (ii) at the Issuer's election, upon certain retirement events and qualifying terminations (a "Non-Voluntary Conversion"). For Voluntary Conversions, the Class B OP Units will be convertible into Class A OP Units by dividing the average cash available for distribution per unit on the series of specific Class B OP Units over the one-year period prior to conversion by 110% (the "Conversion Percentage") of the cash available for distribution per unit on the Class A OP Units determined over the same period. |
(6) | For Non-Voluntary Conversions, the same formula is used, but the Conversion Percentage can be 120%, 115%, or 110% depending upon the type and timing of the Non-Voluntary Conversion. |
(7) | Consists of the Reporting Person's pecuniary interest in 35,461 Class B OP Units in the Partnership held by Hillsboro, for which the Reporting Person has or shares voting and investment power. |
(8) | The Reporting Person's total direct and indirect beneficial ownership of Class B OP Units following the reported transaction above is 1,638,142 Class B OP Units, which includes those Class B OP Units reported on the Form 3 and the Class B OP Units reported herein. The 1,638,142 Class B OP Units do not include derivative securities of other classes of the Reporting Person that were reported on Form 4 on August 12, 2015 or the Form 3 or non-derivative securities of the Reporting Person reported on Forms 4 dated April 30, 2015 and August 18, 2015, respectively. |