3: Initial statement of beneficial ownership of securities
Published on April 20, 2017
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIESFiled 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 04/20/2017 |
3. Issuer Name and Ticker or Trading Symbol
Select Energy Services, Inc. [ WTTR ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| 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) |
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| 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) | ||
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| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Stock Options (right to buy) | (1) | (1) | Class A common stock | 11,218 | 21.12 | D | |
| Stock Options (right to buy) | (2) | (2) | Class A common stock | 7,479 | 21.12 | D | |
| Stock Options (right to buy) | (3) | (3) | Class A common stock | 13,476 | 14.33 | D | |
| Stock Options (right to buy) | (4) | (4) | Class A common stock | 5,334 | 20 | D | |
| Restricted Stock Units | (5) | (5) | Class A common stock | 1,250 | 0 | D | |
| Explanation of Responses: |
| 1. The stock options are exercisable as to 100% of the shares of Class A common stock. The option expires on March 16, 2022. |
| 2. The stock options are exercisable as to 100% of the shares of Class A common stock. The option expires on April 6, 2022. |
| 3. The stock options are exercisable as to 100% of the shares of Class A common stock. The option expires on May 7, 2020. |
| 4. The stock options shall vest and become exercisable as to 100% of the shares of Class A common stock on the first anniversary of the grant date, January 23, 2018. The option expires on January 23, 2027. |
| 5. Each restricted stock unit represents a contingent right to receive one share of Class A common stock. The restricted stock units will be settled in Class A common stock, cash equal to the fair market value of the specified number of shares of Class A common stock covered by the restricted stock units, or any combination thereof determined by the administrator at the date of grant or thereafter. The restricted stock units vest on the first anniversary of the grant date, January 23, 2018. |
| Remarks: |
| This Form 3 is being filed in connection with the effectiveness of the Registration Statement on Form S-1 (Registration No. 333-216404) of Select Energy Services, Inc. See attached for Exhibit 24 - Power of Attorney |
| /s/ Douglas J. Wall by Adam Law, as Attorney-in-Fact | 04/20/2017 | |
| ** 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.
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 Number.