Massachusetts
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45-3231576
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(State or Other Jurisdiction of
Incorporation or Organization)
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(I.R.S. Employer Identification No.)
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Mr. David P. Mansfield
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Edward A. Quint, Esq.
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President and Chief Executive Officer
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Thomas P. Hutton, Esq.
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Provident Bancorp, Inc.
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Luse Gorman, PC
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5 Market Street
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5335 Wisconsin Ave., N.W., Suite 780
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Amesbury, Massachusetts 01913
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Washington, DC 20015-2035
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(978) 388-0050
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(202) 274-2000
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(Name, Address and Telephone
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Number of Agent for Service)
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Large accelerated filer [ ]
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Accelerated filer [ ]
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Non-accelerated filer [ ]
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Smaller reporting company [X]
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(Do not check if a smaller reporting company)
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Title of
Securities
to be
Registered
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Amount
to be
Registered
(1)
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Proposed
Maximum
Offering Price
Per Share
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Proposed
Maximum
Aggregate
Offering Price
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Amount of
Registration
Fee
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Common stock, par value $0.01 per share
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625,015
(2)
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$17.37
(4)
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$10,856,511
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$1,259
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Stock Options
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446,440
(3)
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----
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----
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N/A
(5)
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(1)
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Together with an indeterminate number of additional shares that may be necessary to adjust the number of shares reserved for issuance pursuant to the Provident Bancorp, Inc. 2016 Equity Incentive Plan (the “Equity Plan”) as a result of a stock split, stock dividend or similar adjustment of the outstanding common stock of Provident Bancorp, Inc. (the “Company”) pursuant to 17 C.F.R. Section 230.416(a) under the Securities Act of 1933, as amended (the “Securities Act”).
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(2)
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Represents the number of shares of common stock reserved for issuance under the Equity Plan for any future grants of stock options and restricted stock.
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(3)
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Represents the number of stock options reserved for issuance under the Equity Plan for any future grants of stock options.
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(4)
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Determined pursuant to 17 C.F.R. Section 230.457(h)(1) of the Securities Act.
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(5)
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Pursuant to 17 C.F.R. Section 230.457(h)(3) of the Securities Act, no registration fee is required to be paid.
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________________________
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Regulation S-K
Exhibit Number
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Document
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Reference to Prior Filing or
Exhibit No. Attached Hereto
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4
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Form of Common Stock Certificate
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*
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5
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Opinion of Luse Gorman, PC
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Attached as Exhibit 5
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10.1
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Provident Bancorp, Inc. 2016 Equity Incentive Plan
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**
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10.2
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Form of Incentive Stock Option Award Agreement
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Attached as Exhibit 10.2
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10.3
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Form of Non-Statutory Stock Option Award Agreement
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Attached as Exhibit 10.3
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10.4
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Form of Restricted Stock Award Agreement
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Attached as Exhibit 10.4
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23.1
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Consent of Luse Gorman, PC
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Contained in Exhibit 5
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23.2
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Consent of Independent Registered Public Accounting Firm
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Attached as Exhibit 23.2
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24
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Power of Attorney
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Contained on Signature Page
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*
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Incorporated by reference to Exhibit 4 to the Registration Statement on Form S-1 (File No. 333-202716) originally filed by the Company under the Securities Act with the Commission on March 13, 2015, and all amendments or reports filed for the purpose of updating such description.
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**
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Incorporated by reference to Appendix A to the definitive proxy statement for the Special Meeting of Shareholders of Provident Bancorp, Inc. (File No. 001-37504), filed by the Company under the Exchange Act on August 9, 2016.
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PROVIDENT BANCORP, INC.
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By:
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/s/ David P. Mansfield |
David P. Mansfield
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President and Chief Executive Officer
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(Duly Authorized Representative)
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Signatures
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Title
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Date
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/s/ David P. Mansfield |
Director, President and Chief Executive Officer
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November 17, 2016
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David P. Mansfield
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(Principal Executive Officer)
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/s/ Carol L. Houle |
Executive Vice President and Chief Financial Officer
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November 17, 2016
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Carol L. Houle
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(Principal Financial and Accounting Officer)
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/s/ John K. Bosen
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Chairman of the Board
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November 17, 2016
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John K. Bosen
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Signatures
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Title
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Date
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/s/ Frank G. Cousins, Jr.
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Director
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November 17, 2016
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Frank G. Cousins, Jr.
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/s/ James A. DeLeo
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Director
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November 17
,
2016
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James A. DeLeo
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/s/ Lisa DeStefano
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Director
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November 17, 2016
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Lisa DeStefano
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/s/ Laurie H. Knapp
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Director
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November 17, 2016
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Laurie H. Knapp
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/s/ Richard L. Peeke
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Director
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November 17, 2016
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Richard L. Peeke
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/s/ Arthur Sullivan
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Director
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November 17, 2016
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Arthur Sullivan
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Exhibit Number
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Description
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4
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Incorporated by reference to Exhibit 4 to the Registration Statement on Form S-1 (File No. 333-202716) originally filed by the Company under the Securities Act with the Commission on March 13, 2015, and all amendments or reports filed for the purpose of updating such description.
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5
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Opinion of Luse Gorman, PC
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10.1
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Provident Bancorp, Inc. 2016 Equity Incentive Plan (incorporated by reference to Appendix A to the definitive proxy statement for the Special Meeting of Shareholders of Provident Bancorp, Inc. (File No. 001-37504), filed by the Company under the Exchange Act on August 9, 2016).
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10.2
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Form of Incentive Stock Option Award Agreement
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10.3
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Form of Non-Statutory Stock Option Award Agreement
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10.4
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Form of Restricted Stock Award Agreement
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23.1
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Consent of Luse Gorman, PC (contained in the opinion included as Exhibit 5).
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23.2
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Consent of Independent Registered Public Accounting Firm.
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24
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Power of Attorney (contained in the signature page to this Registration Statement).
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Re:
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Provident Bancorp, Inc.
-
Registration Statement on Form S-8
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Very truly yours,
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/s/ Luse Gorman, PC
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LUSE GORMAN, PC
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3.
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Total number of shares of Company common stock, $0.01 par value per share, that may be acquired pursuant to this Option
:_____________________
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·
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This is an Incentive Stock Option (“
ISO
”) to the maximum extent permitted under Code Section 422(d).
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6.
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Vesting Schedule
. Except as otherwise provided in this Agreement, this Option first becomes exercisable, subject to the Option’s expiration date, in accordance
with the vesting schedule specified herein.
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7.1
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Delivery of Notice of Exercise of Option
. This Option will be exercised in whole or in part by the Participant’s delivery to the Company of written notice (the “
Notice of Exercise of Option
” attached hereto as Exhibit A or as otherwise acceptable to the Company) setting forth the number of shares with respect to which this Option is to be exercised, together with payment by cash or other means acceptable to the Committee, including:
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·
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by tendering, either actually or by attestation, shares of Stock valued at Fair Market Value as of the day of exercise.
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Cash or personal, certified or cashier’s check in the sum of $_______, in full/partial payment of the purchase price.
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·
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Stock of the Company with a fair market value of $______ in full/partial payment of the purchase price.
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·
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By a net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding).
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·
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By selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price.
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7.2
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“Fair Market Value”
shall have the meaning set forth in Section 8.1(s) of the Plan.
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8.1
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Delivery of Shares
. Delivery of shares of Common Stock upon the exercise of this Option will comply with all applicable laws (including the requirements of the Securities Act) and the applicable requirements of any securities exchange or similar entity.
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9.1
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In the event of the Participant’s Involuntary Termination of Employment following a Change in Control, all Options held by the Participant, whether or not exercisable at such time, will become fully exercisable, subject to the expiration provisions otherwise applicable to the Option.
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9.2
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A “
Change in Control
” will be deemed to have occurred as provided in Section 4.2 of the Plan.
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This Option, including the number of shares subject to the Option and the exercise price, will be adjusted upon the occurrence of the events specified in, and in accordance with the provisions of Section 3.4 of the Plan.
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(i)
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Death
. This Option will become exercisable as to all shares subject to an outstanding Award, whether or not then exercisable, in the event of the Participant’s Termination of Service by reason of the Participant’s death. This Option may thereafter be exercised by the Participant’s legal representative or beneficiaries for a period of one (1) year from the date of death, subject to termination on the expiration date of this Option, if earlier.
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(iii)
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Retirement.
Vested Options may be exercised for a period of one (1) year from the date of Termination of Service by reason of Retirement, subject to termination on the Option’s expiration date, if earlier (and, for purposes of clarity, non-vested Options will be forfeited on the date of Termination of Service by reason of Retirement). “Retirement” shall have the meaning set forth in Section 8.1(dd) of the Plan. Options exercised more than three months following Retirement will not have ISO treatment.
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(iv)
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Termination for Cause
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If the Participant’s Service has been terminated for Cause, all Options that have not been exercised will expire and be forfeited.
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(v)
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Other Termination
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If the Participant’s Service terminates for any reason other than due to death, Disability, Retirement, Involuntary Termination following a Change in Control or for Cause, this Option may thereafter be exercised, to the extent it was exercisable at the time of such termination, for a period of three months following termination, subject to termination on the Option’s expiration date, if earlier.
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12.1
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No Option will confer upon the Participant any rights as a stockholder of the Company prior to the date on which the individual fulfills all conditions for receipt of such rights.
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12.2
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This Agreement may not be amended or otherwise modified unless evidenced in writing and signed by the Company and the Participant.
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12.3
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Except as otherwise provided by the Committee, ISOs under the Plan are not transferable except (1) as designated by the Participant by will or by the laws of descent and distribution, (2) to a trust established by the Participant, or (3) between spouses incident to a divorce or pursuant to a domestic relations order, provided, however, that in the case of a transfer described under (3), the Option will not qualify as an ISO as of the day of such transfer.
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12.4
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This Agreement will be governed by and construed in accordance with the laws of the Commonwealth of Massachusetts.
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12.5
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This Agreement is subject to all laws, regulations and orders of any governmental authority which may be applicable thereto and, notwithstanding any of the provisions hereof, the Participant agrees that he will not exercise the Option granted hereby nor will the Company be obligated to issue any shares of stock hereunder if the exercise thereof or the issuance of such shares, as the case may be, would constitute a violation by the Participant or the Company of any such law, regulation or order or any provision thereof.
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PROVIDENT BANCORP, INC.
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By:
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Its: |
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PARTICIPANT
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___
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Cash or personal, certified or cashier’s check in the sum of $_______, in full/partial payment of the purchase price.
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___
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Stock of the Company with a fair market value of $______ in full/partial payment of the purchase price.*
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___
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My check in the sum of $_______
and
stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.*
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___
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A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding).
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___
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Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price.
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3.
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Total number of shares of Company common stock, $0.01 par value per share, that may be acquired pursuant to this Option
:______________________
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·
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This is a Non-Qualified Option.
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6.
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Vesting Schedule
. Except as otherwise provided in this Agreement, this Option first becomes exercisable, subject to the Option’s expiration date, in accordance with the vesting schedule specified herein.
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7.1
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Delivery of Notice of Exercise of Option
. This Option will be exercised in whole or in part by the Participant’s delivery to the Company of written notice (the “
Notice of Exercise of Option
” attached hereto as Exhibit A or as otherwise acceptable to the Company) setting forth the number of shares with respect to which this Option is to be exercised, together with payment by cash or other means acceptable to the Committee, including:
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·
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By tendering, either actually or by attestation, shares of Stock valued at Fair Market Value as of the day of exercise.
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·
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Cash or personal, certified or cashier’s check in the sum of $_______, in full/partial payment of the purchase price.
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·
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Stock of the Company with a fair market value of $______ in full/partial payment of the purchase price.
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·
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By a net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding).
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·
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By selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price.
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7.2
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“Fair Market Value”
shall have the meaning set forth in Section 8.1(s) of the Plan.
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8.1
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Delivery of Shares
. Delivery of shares of Common Stock upon the exercise of this Option will comply with all applicable laws (including the requirements of the Securities Act) and the applicable requirements of any securities exchange or similar entity.
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9.1
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In the event of the Participant’s Involuntary Termination of Employment or Involuntary Termination of Service as a Director following a Change in Control, all Options held by the Participant, whether or not exercisable at such time, will become fully exercisable, subject to the expiration provisions otherwise applicable to the Option.
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9.2
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A “
Change in Control
” will be deemed to have occurred as provided in Section 4.2 of the Plan.
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This Option, including the number of shares subject to the Option and the exercise price, will be adjusted upon the occurrence of the events specified in, and in accordance with the provisions of Section 3.4 of the Plan.
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(i)
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Death
. This Option will become exercisable as to all shares subject to an outstanding Award, whether or not then exercisable, in the event of the Participant’s Termination of Service by reason of the Participant’s death. This Option may thereafter be exercised by the Participant’s legal representative or beneficiaries for a period of one (1) year from the date of death, subject to termination on the expiration date of this Option, if earlier.
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(iii)
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Retirement
. Vested Options may be exercised for a period of one (1) year from the date of Termination of Service by reason of Retirement, subject to termination on the Option’s expiration date, if earlier (and, for purposes of clarity, non-vested Options will be forfeited on the date of Termination of Service by reason of Retirement). “Retirement” shall have the meaning set forth in Section 8.1(dd) of the Plan.
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(iv)
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Termination for Cause
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If the Participant’s Service has been terminated for Cause, all Options that have not been exercised will expire and be forfeited.
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(v)
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Other Termination
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If the Participant’s Service terminates for any reason other than due to death, Disability, Retirement, Involuntary Termination following a Change in Control or for Cause, this Option may thereafter be exercised, to the extent it was exercisable at the time of such termination, for a period of three months following termination, subject to termination on the Option’s expiration date, if earlier.
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12.1
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No Option will confer upon the Participant any rights as a stockholder of the Company prior to the date on which the individual fulfills all conditions for receipt of such rights.
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12.2
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This Agreement may not be amended or otherwise modified unless evidenced in writing and signed by the Company and the Participant.
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12.3
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In the discretion of the Committee, a non-qualified Option granted under the Plan may be transferable by the Participant, provided, however, that such transfers will be limited to Immediate Family Members of Participants, trusts and partnerships established for the primary benefit of such family members or to charitable organizations, and provided, further, that such transfers are not made for consideration to the Participant.
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12.4
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This Agreement will be governed by and construed in accordance with the laws of the Commonwealth of Massachusetts.
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12.5
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This Agreement is subject to all laws, regulations and orders of any governmental authority which may be applicable thereto and, notwithstanding any of the provisions hereof, the Participant agrees that he will not exercise the Option granted hereby nor will the Company be obligated to issue any shares of stock hereunder if the exercise thereof or the issuance of such shares, as the case may be, would constitute a violation by the Participant or the Company of any such law, regulation or order or any provision thereof.
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___
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Cash or personal, certified or cashier’s check in the sum of $_______, in full/partial payment of the purchase price.
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___
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Stock of the Company with a fair market value of $______ in full/partial payment of the purchase price.*
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___
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My check in the sum of $_______
and
stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.*
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___
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A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding).
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___
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Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price.
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3.
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Total number of shares of Company common stock, $0.01 par value per share, covered by the Restricted Stock Award: ___________________________
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4.
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Vesting Schedule
. Except as otherwise provided in this Agreement, this Restricted Stock Award first becomes earned in accordance with the vesting schedule specified
herein.
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6.
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Terms and Conditions
.
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6.1
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The Participant will have the right to vote the shares of Restricted Stock awarded hereunder on matters which require shareholder vote.
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6.2
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Any cash dividends or distributions declared with respect to shares of Stock subject to the Restricted Stock Award will be distributed to the Participant at the time the Restricted Stock vests.
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7.
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Delivery of Shares
.
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8.1
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In the event of the Participant’s Involuntary Termination of Employment following a Change in Control or Involuntary Termination of Service as a Director following a Change in Control, all Restricted Stock Awards held by the Participant will become fully vested.
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8.2
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A “
Change in Control
” will be deemed to have occurred as provided in Section 4.2 of the Plan.
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This Restricted Stock Award, including the number of shares subject to the Restricted Stock Award, will be adjusted upon the occurrence of the events specified in, and in accordance with the provisions of, Section 3.4 of the Plan.
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(i)
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Death
. In the event of the Participant’s Termination of Service by reason of the Participant’s death, all Restricted Stock will vest as to all shares subject to an outstanding Award, whether or not immediately vested, at the date of Termination of Service.
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(ii)
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Disability
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In the event of the Participant’s Termination of Service by reason of Disability, all Restricted Stock will vest as to all shares subject to an outstanding Award, whether or not immediately vested, at the date of Termination of Service
.
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(iii)
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Retirement
. In the event of the Participant’s Termination of Service by reason of the Participant’s Retirement, any Restricted Stock award that has not vested as of the date of Termination of Service will expire and be forfeited. “Retirement” shall have the meaning set forth in Section 8.1(dd) of the Plan.
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(iv)
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Termination for Cause
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If the Participant’s Service has been terminated for Cause, all Restricted Stock granted to a Participant that has not vested will expire and be forfeited.
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(iv)
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Other Termination
.
If a Participant terminates Service for any reason other than due to death, Disability, Retirement, Involuntary Termination following a Change in Control or for Cause, all shares of Restricted Stock awarded to the Participant which have not vested as of the date of Termination of Service will expire and be forfeited.
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11.1
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No Restricted Stock Award will confer upon the Participant any rights as a stockholder of the Company prior to the date on which the individual fulfills all conditions for receipt of such rights.
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11.2
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This Agreement may not be amended or otherwise modified unless evidenced in writing and signed by the Company and the Participant.
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11.3
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Restricted Stock Awards are not transferable prior to the time such Awards vest in the Participant.
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11.4
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This Restricted Stock Award will be governed by and construed in accordance with the laws of the Commonwealth of Massachusetts.
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11.5
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This Restricted Stock Award is subject to all laws, regulations and orders of any governmental authority which may be applicable thereto and, notwithstanding any of the provisions hereof, the Company will not be obligated to issue any shares of stock hereunder if the issuance of such shares would constitute a violation of any such law, regulation or order or any provision thereof.
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