Statement of Changes in Beneficial Ownership (4)
26 October 2021 - 7:39AM
Edgar (US Regulatory)
FORM 4
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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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
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Govil Shivani |
2. Issuer Name and Ticker or Trading Symbol
CCC Intelligent Solutions Holdings Inc.
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CCCS
]
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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)
See Remarks |
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(Last)
(First)
(Middle)
C/O CCC INTELLIGENT SOLUTIONS HOLDINGS, 222 MERCHANDISE MART PLAZA, SUITE 900 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
10/21/2021 |
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(Street)
CHICAGO, IL 60654
(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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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 |
| Restricted Stock Unit (1) | $0 | 10/21/2021 | | A | | 50000 | | (1) | (1) | Common Stock | 50000 | $0 | 50000 | D | |
| Performance Restricted Stock Unit (2) | $0 | 10/21/2021 | | A | | 25000 | | (2) | (2) | Common Stock | 25000 (2) | $0 | 25000 | D | |
| Explanation of Responses: |
| (1) | The Reporting Person was granted Restricted Stock Units ("RSUs") which represent a contingent right to receive, at the Issuer's discretion, (i) one share of Common Stock for each RSU, (ii) an amount of cash equal to the fair market value of such share of Common Stock on the date immediately preceding the date of settlement of the RSU, or (iii) a combination thereof. Twenty-five (25%) of the RSUs vest upon each of the first four anniversaries of July 30, 2021, generally subject to the Reporting Person's continued service to the Issuer through each such vesting and settlement date. |
| (2) | The Reporting Person was granted Performance Restricted Stock Units ("PSUs") which represent a contingent right to receive, at the Issuer's discretion, (i) a distribution of a number of shares of the Issuer's Common Stock equal to 0% to 200% (or such greater percentage as is determined by the Board of Directors of the Issuer) of the PSUs, (ii) an amount of cash equal to the fair market value of such number of shares of the Issuer's Common Stock on the date immediately preceding the date of settlement of the PSUs, or (iii) a combination thereof, in all cases based on the total shareholder return realized by the Issuer's stockholders over the period August 2, 2021 through December 31, 2023 and generally subject to the Reporting Person's continued service to the Issuer through the Issuer's certification of the performance results. |
Remarks:
Senior Vice President, Chief Product Officer |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Govil Shivani
C/O CCC INTELLIGENT SOLUTIONS HOLDINGS
222 MERCHANDISE MART PLAZA, SUITE 900
CHICAGO, IL 60654 |
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| See Remarks |
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Signatures
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| /s/ Kevin Kane as Attorney-in-Fact for Shivani Govil | | 10/25/2021 |
| **Signature of Reporting Person | Date |
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