SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL 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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Hoyd Kendall

(Last) (First) (Middle)
4900 EAST HUNTER AVENUE

(Street)
ANAHEIM CA 92807

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/13/2018
3. Issuer Name and Ticker or Trading Symbol
Select Interior Concepts, Inc. [ SIC ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Financial Officer
5. 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 Beneficially Owned
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)
Class A Common Stock 66,355 D
Class A Common Stock 19,211(1) D
Class A Common Stock 76,844(2) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Phantom Stock (3) (3) Class A Common Stock 76,844 (3) D
Explanation of Responses:
1. These shares of Class A Common Stock were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on November 22, 2017, and will vest in equal installments annually over three years, provided that the Reporting Person remains in the service of the Issuer through the applicable vesting date.
2. These shares of Class A Common Stock were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on November 22, 2017, and will vest in equal installments annually over three years upon the achievement by the Issuer of certain performance goals, provided that the Reporting Person remains in the service of the Issuer through the applicable vesting date.
3. The phantom stock is economically equivalent to the Issuer's Class A Common Stock. These phantom stock were granted by the Issuer to the Reporting Person under the Issuer's 2017 Incentive Compensation Plan on November 22, 2017, and will vest upon the achievement by the Issuer of certain performance goals and be settled in cash on such vesting date, provided that the Reporting Person remains in the service of the Issuer through such vesting date.
Remarks:
Exhibit List Exhibit 24 - Limited Power of Attorney for Section 16 Reporting Obligations
/s/ Tyrone Johnson, attorney-in-fact 08/13/2018
** 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.