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SEC FORM<br /> 3

SEC Form 3

FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*

Jacobs Justin

(Last) (First) (Middle)
382 GREENWICH AVENUE
SUITE ONE

(Street)

GREENWICH CT 06830

(City) (State) (Zip)
2. Date of Event Requiring Statement
(Month/Day/Year)

03/15/2019
3. Issuer Name and Ticker or Trading Symbol

SCHOOL SPECIALTY INC
[ SCOO ]
4. Relationship of Reporting Person(s) to Issuer

(Check all applicable)

X Director X 10% Owner
Officer (give title below) Other (specify below)
5. 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 Beneficially Owned
1. Title of Security (Instr.
4)
2.
Amount of Securities Beneficially Owned (Instr.
4)
3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
4. Nature of Indirect Beneficial Ownership (Instr.
5)
Common Stock, $0.001 par value 2,423,516 I See footnote(1)
Common Stock, $0.001 par value 3,870 I See footnote(2)
Table II – Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr.
4)
2. Date Exercisable and Expiration Date
(Month/Day/Year)
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
6. Nature of Indirect Beneficial Ownership (Instr.
5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. The shares reported are directly held by Mill Road Capital II, L.P. (the “Fund”). Mr. Jacobs is a management committee director of Mill Road Capital II GP LLC (the “GP”), which is the sole general partner of the Fund and has sole authority to vote (or direct the vote of), and to dispose (or direct the disposal) of, these shares on behalf of the Fund. The Reporting Person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein, if any.
2. Represents RSUs granted by the issuer to Scott Scharfman, a management committee director of the GP, as compensation for serving as a member of the issuer’s board of directors, in which the Reporting Person may have an indirect pecuniary interest. The Reporting Person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein, if any.
Remarks:
/s/ Justin C. Jacobs 03/19/2019
** 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
5

(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.


Exhibit 24
CONFIRMING STATEMENT
This Statement confirms that the undersigned has authorized and designated
Thomas E. Lynch and Scott P. Scharfman, each acting singly, to execute and file
on the undersigned’s behalf all Forms 3, 4 and 5 and Schedule 13D (including any
amendments thereto) that the undersigned may be required to file with the U.S.
Securities and Exchange Commission as a result of the undersigned’s ownership of
or transactions in securities of School Specialty, Inc., a Delaware corporation.
The authority of Thomas E. Lynch and Scott P. Scharfman under this Statement
shall continue until the undersigned is no longer required to file any of Forms
3, 4 and 5 and Schedule 13D with regard to the undersigned’s ownership of or
transactions in securities of School Specialty, Inc. unless earlier revoked in
writing. The undersigned acknowledges that Thomas E. Lynch and Scott P.
Scharfman
are not assuming any of the undersigned’s responsibilities to comply with
Section 16
or Section 13 of the Securities Exchange Act of 1934, as amended.

Dated: March 19, 2019 /s/ Justin C. Jacobs
Justin C. Jacobs