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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 | |
HELLMAN ROBERT B JR 950 TOWER LANE, SUITE 800 FOSTER CITY, CA 94404 |
X | X |
/s/ Robert B. Hellman, Jr. | 01/26/2011 | |
**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) | Pro rata distribution by CFSI LLC, a Delaware limited liability company ("CFSI"), of common units representing limited partner interests in StoneMor Partners L.P. ("StoneMor"), to its members, including MDC IV Trust U/T/A November 30, 2010 ("MDC IV Trust"), MDC IV Associates Trust U/T/A November 30, 2010 ("MDC IVA Trust") and Delta Trust U/T/A November 30, 2010 ("Delta Trust" and collectively with MDC IV Trust and MDC IVA Trust, the "Trusts") and Cornerstone Family Services LLC, a Delaware limited liability company ("Cornerstone"). |
(2) | Pro rata distribution by Cornerstone of common units representing limited partner interests in StoneMor to its members, including the Trusts. |
(3) | Voting and investment decisions for each of the Trusts are directed by Gen4 Trust Advisor LLC, a Delaware limited liability company (the "Trust Advisor"), of which Mr. Robert B. Hellman Jr. serves as the sole member and, in such capacity, has investment and voting control over the securities held by the Trusts. The Trusts and the Trust Advisor file Section 16 reports separately from Mr. Hellman. |
(4) | The securities are held directly by MDC IV Trust. Of these securities, 206,987 common units were received by virtue of the distribution by CFSI and 1,577,216 common units were received by virtue of the distribution by Cornerstone. Mr. Hellman is a beneficiary of MDC IV Trust and disclaims beneficial ownership over the securities held by MDC IV Trust except to the extent of his proportionate pecuniary interest therein. |
(5) | The securities are held directly by MDC IVA Trust. Of these securities, 3,189 common units were received by virtue of the distribution by CFSI and 33,523 common units were received by virtue of the distribution by Cornerstone. Mr. Hellman is a beneficiary of MDC IVA Trust and disclaims beneficial ownership over the securities held by MDC IVA Trust except to the extent of his proportionate pecuniary interest therein. |
(6) | The securities are held directly by Delta Trust. Of these securities, 3,077 common units were received by virtue of the distribution by CFSI and 25,374 common units were received by virtue of the distribution by Cornerstone. Mr. Hellman is a beneficiary of Delta Trust and disclaims beneficial ownership over the securities held by Delta Trust except to the extent of his proportionate pecuniary interest therein. |