SEC FORM 4 SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
 
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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).
1. Name and Address of Reporting Person*
Crotwell Jim

(Last) (First) (Middle)
500 SOUTH SERVICE ROAD EAST

(Street)
RUSTON LA 71270

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Origin Bancorp, Inc. [ OBNK ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Risk Officer
3. Date of Earliest Transaction (Month/Day/Year)
02/17/2023
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 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
Common Stock 02/17/2023 M 489 A (1) 4,337(2) D
Common Stock 02/17/2023 F(3) 169 D $39.64 4,168(2) D
Common Stock 9,082 I BY ISSUER RETIREMENT PLAN
Common Stock 3,000 I By IRA
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 (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 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 (Month/Day/Year) 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: 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 Units (1) 02/17/2023 M 489 (4) (4) Common Stock 489 $0 976(4) D
Restricted Stock Units (5) 02/17/2023 A 2,144 (6) (6) Common Stock 2,144 $0 2,144(6) D
Restricted Stock Units (5) (7) (7) Common Stock 2,064 2,064(7) D
Explanation of Responses:
1. Restricted stock units convert into common stock on a one-for-one basis.
2. Includes 553 shares of Common Stock purchased pursuant to the Origin Bancorp, Inc. 2021 Employee Stock Purchase Plan ("ESPP"), for the purchase period of June 01, 2021 to May 31, 2022.
3. Represents the number of common stock that have been withheld by the issuer to satisfy its income tax withholding and remittance obligations in connection with the net settlement of the restricted stock units and does not represent a sale.
4. Granted on February 18, 2022, vesting ratably over three years with the first vest date of February 17, 2023.
5. Each restricted stock unit represents the contingent right to receive, at settlement, one share of the issuer's common stock or cash equal to the fair value thereof (calculated pursuant to the incentive agreement), as determined by the issuer.
6. Granted on February 17, 2023, vesting ratably over three years with the first vest date of February 17, 2024.
7. Granted on August 20, 2021, vesting ratably over three years with the first vest date of August 19, 2022.
Remarks:
/s/ Drake Mills, as Attorney-in-Fact 02/22/2023
** 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.