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*
Kouzelos Michael P

(Last) (First) (Middle)
C/O CBIZ, INC.
6050 OAK TREE BOULEVARD SOUTH

(Street)
CLEVELAND OH 44131

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CBIZ, Inc. [ CBZ ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President, Employee Services
3. Date of Earliest Transaction (Month/Day/Year)
02/19/2021
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 02/19/2021 M(1) 21,222 A $9.35 305,406 D
Common Stock 02/19/2021 S 21,222 D $29.3527(2) 284,184 D
Common Stock 02/22/2021 M(1) 14,778 A $9.35 298,962 D
Common Stock 02/22/2021 S 14,778 D $30.1029(3) 284,184 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 (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
Employee Stock Option $9.35 02/19/2021 M 21,222 05/15/2016 05/15/2021 Common Stock 21,222 $0 14,778 D
Employee Stock Option $9.35 02/22/2021 M 14,778 05/15/2016 05/15/2021 Common Stock 14,778 $0 0 D
Employee Stock Option $10.35 05/10/2017 05/10/2022 Common Stock 72,000 72,000 D
Employee Stock Option $15.55 05/10/2018 05/10/2023 Common Stock 72,000 72,000 D
Employee Stock Option $19.45 05/09/2019 05/09/2024 Common Stock 72,000 72,000 D
Restricted Stock Units $0 03/20/2020 03/20/2022 Common Stock 19,291 19,291 D
Restricted Stock Units $0 02/27/2021 02/27/2023 Common Stock 14,379 14,379 D
Restricted Stock Units $0 02/11/2022 02/11/2024 Common Stock 16,121 16,121 D
Explanation of Responses:
1. Consists of Option granted 05/15/2015, vesting in 25% increments each year beginning 05/15/2016, and expiring on 05/15/2021.
2. Weighted average sale price of price range between $29.365 and $29.43. Will provide upon request number of shares sold at each separate price.
3. Weighted average sale price of price range between $29.33 and $30.39. Will provide upon request number of shares sold at each separate price.
/s/ Michael W Gleespen, attorney-in-fact for Michael P Kouzelos 02/23/2021
** 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).
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