Sec Form 4 Filing - Greenblatt William Mitchell @ Andover National Corp - 2021-10-05

Insider filing report for Changes in Beneficial Ownership
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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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Greenblatt William Mitchell
2. Issuer Name and Ticker or Trading Symbol
Andover National Corp [ NONE]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O ANDOVER NATIONAL CORPORATION,, 333 AVENUE OF THE AMERICAS SUITE 2000
3. Date of Earliest Transaction (MM/DD/YY)
10/05/2021
(Street)
MIAMI, FL33131-2185
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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
Class A Common Stock ( 1 ) 10/05/2021 D 7,500 D 2,500 D
Class A Common Stock ( 1 ) 10/05/2021 A 9,375 A 11,875 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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Greenblatt William Mitchell
C/O ANDOVER NATIONAL CORPORATION,
333 AVENUE OF THE AMERICAS SUITE 2000
MIAMI, FL33131-2185
X
Signatures
/s/ Daniel Bagliebter, Power of Attorney For: William Greenblatt 10/05/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )On October 5, 2021, the Issuer cancelled 7,500 unvested restricted stock units ("RSUs") previously granted under the Andover National Corporation 2019 Equity Incentive Plan (the "Plan") in exchange for 9,375 performance RSUs ("PSUs"). Each PSU represents a contingent right to receive one share of the Issuer's Class A common stock. In addition to time-based vesting, the PSUs are also subject to performance vesting that is only satisfied upon the occurrence of a "Liquidity Event" (as defined in the PSU Agreement to include the listing of a class of the Issuer's equity security on a national securities exchange or the occurrence of a Change of Control (as defined in the Plan)) and continued service with the Issuer through the applicable vesting date. For the time-based vesting component, beginning on October 29, 2021, 9,375 PSUs vest in (6) six equal quarterly installments.

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).
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