Statement of Changes in Beneficial Ownership (4)
October 14 2021 - 4:08PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Gomez Alfredo |
2. Issuer Name and Ticker or Trading Symbol
CarParts.com, Inc.
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PRTS
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
VP, General Counsel |
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(Last)
(First)
(Middle)
2050 W. 190TH STREET, SUITE 400 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
10/14/2021 |
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(Street)
TORRANCE, CA 90504
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common Stock | 10/14/2021 | | M | | 5000 | A | $1.03 | 462941 | D | |
| Common Stock | | | | | | | | 8744 | I | By Son's IRA |
| Common Stock | | | | | | | | 66611 | I | By IRA |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
| Stock Options (Right to Buy) | $1.03 | 10/14/2021 | | M | | | 5000 | (1) | 3/24/2029 | Common Stock | 5000 | $0 | 278216 | D | |
| Explanation of Responses: |
| (1) | The stock option was granted to the Reporting Person on March 25, 2019 under the CarParts.com, Inc. 2016 Equity Incentive Plan. Twenty-five percent of the shares of stock subject to the option vested on the first anniversary of the grant date, and the remainder of the shares subject to the option vest in equal monthly installments thereafter over three years, subject to such Reporting Person's service to the Company through such dates. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Gomez Alfredo
2050 W. 190TH STREET, SUITE 400
TORRANCE, CA 90504 |
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| VP, General Counsel |
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Signatures
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| /s/ Alfredo Gomez | | 10/14/2021 |
| **Signature of Reporting Person | Date |
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