Form 3 Primo Water Corp /CN/ For: May 04 Filed by: Melaragni Anne
FREE Breaking News Alerts from StreetInsider.com!
StreetInsider.com Top Tickers, 4/25/2024
May 7, 2021 4:45 PM EDT
| 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 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person
*
| 4221 WEST BOY SCOUT BOULEVARD |
|
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year)
05/04/2021
|
3. Issuer Name
and
Ticker or Trading Symbol
Primo Water Corp /CN/
[
PRMW
]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Chief Human Resources 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)
|
|
Common Shares
|
5,416
(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 |
|
Stock Option (right to buy)
|
|
08/24/2030 |
Common Shares
|
13,554
|
14.3
|
D
|
|
|
Stock Option (right to buy)
|
|
12/09/2030 |
Common Shares
|
11,817
|
15.84
|
D
|
|
| Explanation of Responses: |
|
|
|
| Remarks: |
| Exhibit List Exhibit 24 - Power of Attorney |
|
/s/ Marni Morgan Poe, Attorney-in-Fact |
05/07/2021 |
|
** 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). |
| 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. |
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
The undersigned hereby appoints each of Marni Morgan Poe and Michael James,
signing singly, as her attorney-in-fact to act for her and in her name solely to
do all or any of the following:
1. To prepare, execute and file in the undersigned's name and on the
undersigned's behalf with the Securities and Exchange Commission any and all
statements regarding her beneficial ownership of securities of Primo Water
Corporation (including acquisitions or dispositions thereof) in her capacity as
an officer of Primo Water Corporation filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 and Form 144 pursuant to Rule 144 under the
Securities Act of 1933, as amended ("Rule 144");
2. To prepare, execute and file in the undersigned's name and on the
undersigned's behalf all Canadian Insider Reports and other SEDI filings
regarding her beneficial ownership of securities of Primo Water Corporation
(including acquisitions or dispositions thereof) in her capacity as an officer
of Primo Water Corporation; and
3. To prepare, execute and file all necessary instruments, including
applications for Form ID, to carry out and perform any of the powers stated
above, and to do any other acts requisite to carrying out such powers.
Neither Marni Morgan Poe nor Michael James shall incur any liability to the
undersigned for acting or refraining from acting under this power, except for
such attorney's own willful misconduct or gross negligence. The undersigned
acknowledges that the foregoing attorneys-in-fact, in serving in such capacity
at the request of the undersigned, are not assuming, nor is Primo Water
Corporation assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934, Rule 144, or applicable
Canadian securities laws.
Any reproduced copy of this signed original shall be deemed to be an original
counterpart of this Power of Attorney.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file statements pursuant to Section 16(a)
of the Securities Exchange Act of 1934, Rule 144, or applicable Canadian
securities laws with respect to the undersigned's beneficial ownership of and
transactions in securities of Primo Water Corporation, unless earlier revoked.
This Power of Attorney shall terminate with respect to the attorneys-in-fact
upon receipt by Marni Morgan Poe or Michael James, as the case may be, from the
undersigned of a written notice of revocation of this Power of Attorney. The
undersigned shall have the right to revoke this Power of Attorney at any time.
IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this
3rd day of May, 2021.
/s/ Anne Melaragni
Name: Anne Melaragni
Tweet
Share
E-mail
