SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Blinderman Viki K

(Last) (First) (Middle)
3040 POST OAK BLVD.
SUITE 300

(Street)
HOUSTON TX 77056

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CARRIAGE SERVICES INC [ CSV ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Principal Financial Officer
3. Date of Earliest Transaction (Month/Day/Year)
03/10/2021
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 03/10/2021 M 25,000 A $22.58 39,225 D
Common Stock 03/10/2021 F 18,285(1) D $36.79 20,940 D
Common Stock 03/10/2021 M 12,000 A $20.06 32,940 D
Common Stock 03/10/2021 F 7,351(2) D $36.79 25,589 D
Common Stock 03/10/2021 M 27,920 A $26.54 53,509 D
Common Stock 03/10/2021 F 22,457(3) D $36.79 31,052 D
Common Stock 03/10/2021 M 15,000 A $25.43 46,052 D
Common Stock 03/10/2021 F 11,740(4) D $36.79 34,312 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options $22.58 03/10/2021 M 25,000 (5) 02/24/2022 Common Stock 25,000 $22.58 0 D
Stock Options $20.06 03/10/2021 M 12,000 (6) 02/23/2026 Common Stock 12,000 $20.06 0 D
Stock Options $26.54 03/10/2021 M 27,920 (7) 03/21/2027 Common Stock 27,920 $26.54 6,980 D
Stock Options $25.43 03/10/2021 M 15,000 (8) 02/14/2028 Common Stock 15,000 $25.43 0 D
Performance Award (9) (9) 12/31/2024 Common Stock 13,974 13,974 D
Explanation of Responses:
1. Represents shares withheld on 3/10/2021 to cover the option price and tax liability associated with the exercise of stock options granted on 2/24/2015.
2. Represents shares withheld on 3/10/2021 to cover the option price and tax liability associated with the exercise of stock options granted on 2/23/2016.
3. Represents shares withheld on 3/10/2021 to cover the option price and tax liability associated with the exercise of stock options granted on 3/21/2017.
4. Represents shares withheld on 3/10/2021 to cover the option price and tax liability associated with the exercise of stock options granted on 2/14/2018.
5. Stock Option grant pursuant to the Carriage Services, Inc. Amended and Restated 2006 Long-Term Incentive Plan granted on 2/24/2015. 25,000 vested options were exercised on 3/10/2021.
6. Stock Options granted pursuant to the Carriage Services, Inc. Second Amended and Restated 2006 Long-Term Incentive Plan granted on 2/23/2016. 12,000 vested options were exercised on 3/10/2021.
7. Stock Options granted pursuant to the Carriage Services, Inc. Second Amended and Restated 2006 Long-Term Incentive Plan granted on 3/21/2017 and 27,920 vested options were exercised on 3/10/2021. The remaining 6,980 options will vest on 3/21/2021.
8. Stock Options granted pursuant to the Carriage Services, Inc. 2017 Omnibus Plan granted on 2/14/2018. 15,000 vested options were exercised on 3/10/2021.
9. Represents performance awards, payable in shares on December 31, 2024 granted under the Carriage Services, Inc. 2017 Omnibus Incentive Plan. The award will vest (if at all) on December 31, 2024 provided that the Company's common stock reaches one of five pre-determined growth targets for a sustained period beginning on the grant date of May 19, 2020 and ending on December 31, 2024.
Remarks:
/s/ Viki K. Blinderman 03/12/2021
** 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 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).
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