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*
DeVita Mark

(Last) (First) (Middle)
C/O HERITAGE-CRYSTAL CLEAN, INC.
2000 CENTER DRIVE, SUITE EAST C300

(Street)
HOFFMAN ESTATES IL 60192

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Heritage-Crystal Clean, Inc. [ HCCI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Financial Officer & EVP
3. Date of Earliest Transaction (Month/Day/Year)
10/17/2023
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 10/17/2023 D 44,333(1) D $45.5 27,000(2) D
Common Stock 10/17/2023 D 27,000(2) D $45.5 0 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
Restricted Stock Units $0.00 10/17/2023 D 36,471 (1) (1) Common Stock 36,471 $45.5(1) 0 D
Explanation of Responses:
1. Pursuant to the Agreement and Plan of Merger, dated as of July 19, 2023 (the "Merger Agreement"), by and among Issuer, JFL-Tiger Acquisition Co., Inc., a Delaware corporation ("Parent"), and JFL-Tiger Merger Sub, Inc., a Delaware corporation and wholly-owned subsidiary of Parent, each share of Issuer common stock, par value $0.01 per share, and each share of Issuer common stock underlying restricted stock units, was automatically cancelled and converted into the right to receive $45.50 in cash without interest, subject to applicable withholding taxes. Pursuant to the Merger Agreement, each Issuer restricted stock award became fully vested and was automatically cancelled and converted into the right to receive $45.50 in cash without interest, subject to applicable withholding taxes.
2. Represents shares of common stock which were not sold in the merger and have been rolled over into investment in an entity affiliated with Parent that indirectly owns 100% of Issuer.
/s/ Mark DeVita 10/17/2023
** 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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