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
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1. Name and Address of Reporting Person*
Trost Keith Edward Jr

(Last) (First) (Middle)
C/O STONEMOR INC., 3331 STREET RD.,
SUITE 200

(Street)
BENSALEM PA 19020

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/10/2022
3. Issuer Name and Ticker or Trading Symbol
Stonemor Inc. [ STON ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
See Remarks
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)
Common Stock 37,500(1) 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
Employee Stock Option (right to buy) (2) 12/18/2029 Common Stock 75,000 $1.2 D
Employee Stock Option (right to buy) (3) 12/03/2030 Common Stock 37,500 $1.71 D
Explanation of Responses:
1. Represents 37,500 restricted shares of common stock of StoneMor Inc. granted to the reporting person on December 3, 2020 under the StoneMor Amended and Restated 2019 Long-Term Incentive Plan, as amended (the "Plan"), which vest in equal annual installments over a three-year period, commencing on the first anniversary following the date of grant.
2. Represents 75,000 options to purchase common stock of StoneMor Inc. granted to the reporting person on December 18, 2019 under the Plan, which vest in equal annual installments over a three-year period, commencing on the first anniversary following the date of grant.
3. Represents 37,500 options to purchase common stock of StoneMor Inc. granted to the reporting person on December 3, 2020 under the Plan, which vest in equal annual installments over a three-year period, commencing on the first anniversary following the date of grant.
Remarks:
Senior Vice President of Corporate Development Exhibit List - Exhibit 24 - Power of Attorney
/s/ Keith Edward Trost, Jr. 06/15/2022
** 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.
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