Initial Statement of Beneficial Ownership (3)
17 Novembro 2022 - 7:19PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
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3235-0104
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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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1. Name and Address of Reporting Person
*
LAISURE CHRISTOPHER |
2. Date of Event Requiring Statement (MM/DD/YYYY)
11/16/2022
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3. Issuer Name and Ticker or Trading Symbol
i3 Verticals, Inc. [IIIV]
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(Last)
(First)
(Middle)
40 BURTON HILLS BLVD., SUITE 415 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
President - Public Sector / |
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(Street)
NASHVILLE, TN 37215
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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) |
| Class A common stock, par value $0.0001 per share | 23700 | D | |
| Class A common stock, par value $0.0001 per share | 35185 | I | By The Laisure Donor Advised Fund |
| Class A common stock, par value $0.0001 per share | 544714 | I | By BIS HQ, GP (1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
| Stock Option (Right to Buy) | (2) | 2/11/2032 | Class A common stock, par value $0.0001 per share | 25000 | $26.53 | D | |
| Explanation of Responses: |
| (1) | The reported securities are held by BIS HQ, GP, a general partnership of which the reporting person is the President. |
| (2) | The option vests ratably in three equal annual installments beginning on the first anniversary of the grant date, subject to the Reporting Person's continued service with the Issuer. The option was granted February 11, 2022. |
Remarks:
Exhibit List: Exhibit 24 Power of Attorney. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
LAISURE CHRISTOPHER
40 BURTON HILLS BLVD.
SUITE 415
NASHVILLE, TN 37215 |
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| President - Public Sector |
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Signatures
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| /s/ Paul Maple, Attorney-in-Fact for Christopher Laisure | | 11/17/2022 |
| **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 control number. |
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