# EDGAR Filing Document

**Accession Number:** 0001016281
**File Stem:** 0001016281-23-000038
**Filing Date:** 2023-2
**Character Count:** 8825
**Document Hash:** a6286d9cbe7c13226cb35aa74f30ee50
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001016281-23-000038.hdr.sgml**: 20230224

**ACCESSION NUMBER**: 0001016281-23-000038

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230222

**FILED AS OF DATE**: 20230224

**DATE AS OF CHANGE**: 20230224

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** PAYNE MELVIN C
- **CENTRAL INDEX KEY:** 0001024177

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-11961
- **FILM NUMBER:** 23668703

**MAIL ADDRESS:**
- **STREET 1:** 3040 POST OAK BLVD
- **STREET 2:** SUITE 300
- **CITY:** HOUSTON
- **STATE:** TX
- **ZIP:** 77056
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** CARRIAGE SERVICES INC
- **CENTRAL INDEX KEY:** 0001016281
- **STANDARD INDUSTRIAL CLASSIFICATION:** SERVICES-PERSONAL SERVICES [7200]
- **IRS NUMBER:** 760423828
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 3040 POST OAK BOULEVARD
- **STREET 2:** SUITE 300
- **CITY:** HOUSTON
- **STATE:** TX
- **ZIP:** 77056
- **BUSINESS PHONE:** 713-332-8400

**MAIL ADDRESS:**
- **STREET 1:** 3040 POST OAK BOULEVARD
- **STREET 2:** SUITE 300
- **CITY:** HOUSTON
- **STATE:** TX
- **ZIP:** 77056

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>PAYNE MELVIN C<br><sub>(Last) (First) (Middle)</sub><br>3040 POST OAK BLVD<br>SUITE 300<br><sub>(Street)</sub><br>HOUSTON, TX 77056<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-22 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_CEO_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>CARRIAGE SERVICES INC [ CSV ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2023-02-22 |  | A |  | 30780<sup>(1)</sup> | A | $32.69 | 1227603 | D |  |
| Common Stock |  |  |  |  |  |  |  | 4164 | I | Melvin C. Payne, Jr. 2016 Annuity Trust |
| Common Stock |  |  |  |  |  |  |  | 24354 | I | Spouse |
| Common Stock |  |  |  |  |  |  |  | 4164 | I | Karen P. Payne 2016 Annuity Trust |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Stock Options | $32.69 | 2023-02-22 |  | A |  | 66666 |  | <sup>(2)</sup> | 2033-02-22 | Common Stock | 66666.0 | <sup>(2)</sup> | 66666 | D |  |
| Stock Options | $49.48 |  |  |  |  |  |  | <sup>(3)</sup> | 2032-02-23 | Common Stock | 80000.0 |  | 80000 | D |  |
| Performance Award | <sup>(4)</sup> |  |  |  |  |  |  | <sup>(4)</sup> | 2024-12-31 | Common Stock | 181019.0 |  | 181019 | D |  |
| Stock Options | <sup>(5)</sup> |  |  |  |  |  |  | <sup>(5)</sup> | 2031-02-17 | Common Stock | 150000.0 |  | 150000 | D |  |
| Stock Options | $34.79 |  |  |  |  |  |  | <sup>(6)</sup> | 2031-02-17 | Common Stock | 150000.0 |  | 150000 | D |  |
| Stock Options | $25.43 |  |  |  |  |  |  | <sup>(7)</sup> | 2028-02-14 | Common Stock | 50000.0 |  | 50000 | D |  |
| Stock Options | $26.54 |  |  |  |  |  |  | <sup>(8)</sup> | 2027-03-21 | Common Stock | 116100.0 |  | 116100 | D |  |
| Stock Options | $20.06 |  |  |  |  |  |  | <sup>(9)</sup> | 2026-02-23 | Common Stock | 54545.0 |  | 54545 | D |  |

---

### Footnotes:

(1) Restricted Stock grant pursuant to the Carriage Services, Inc. 2017 Omnibus Incentive Plan which will vest in equal increments each year over three years beginning 2/22/2024.

(2) Stock Options granted on 2/22/2023 pursuant to the Carriage Services, Inc. 2017 Omnibus Incentive Plan which will vest in equal increments each year over three years beginning 2/22/2024.

(3) Stock Options granted on 2/23/2022 pursuant to the Carriage Services, Inc. 2017 Omnibus Incentive Plan which will vest in equal increments each year over seven years beginning 2/23/2023.

(4) Represents maximum number of performance awards, payable in shares on December 31, 2024 granted under the Carriage Services, Inc. 2017 Omnibus Incentive Plan. The award will vest (if at all) on December 31, 2024 provided that the Company's common stock reaches one of five pre-determined targets for a sustained period beginning on the grant date and ending on December 31, 2024.

(5) Stock Options granted on 2/17/2021 pursuant to the Carriage Services, Inc. 2017 Omnibus Incentive Plan. 50,000 stock options vested on 12/8/2021 when the stock price reached $55.39 per share and 100,000 stock options would immediately vest upon the stock reaching a price of $77.34 per share, as long as each price is reached for three consecutive trading days during the 10 year option term.

(6) Stock Options granted on 2/17/2021 pursuant to the Carriage Services, Inc. 2017 Omnibus Incentive Plan which will vest in equal increments each year over five years beginning 2/17/2022.

(7) Stock Options granted on 2/14/2018 pursuant to the Carriage Services, Inc. 2017 Omnibus Incentive Plan which vested in equal increments each year over five years beginning 2/14/2019.

(8) Stock Options granted on 3/21/2017 pursuant to the Carriage Services, Inc. Second Amended and Restated 2006 Long-Term Incentive Plan which vested in equal increments each year over five years beginning 3/21/2018.

(9) Stock Options granted on 2/23/2016 pursuant to the Carriage Services, Inc. Second Amended and Restated 2006 Long-Term Incentive Plan which vested in equal increments each year over five years beginning 2/23/2017.

**Signature:** /s/ Melvin C. Payne  
**Date:** 2023-02-24

### Remarks:

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.**