Statement of Changes in Beneficial Ownership (4)
19 Maio 2023 - 8:34PM
Edgar (US Regulatory)
FORM 4
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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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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
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Chicago Pacific Founders UGP III, LLC |
2. Issuer Name and Ticker or Trading Symbol
P3 Health Partners Inc.
[
PIII
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
980 NORTH MICHIGAN AVENUE, SUITE 1998, |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/17/2023 |
(Street)
CHICAGO, IL 60611 |
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
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X
_ Form filed by More than One Reporting Person
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(City)
(State)
(Zip)
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Rule 10b5-1(c) Transaction Indication
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Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to
satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Class A Common Stock | 5/17/2023 | | P | | 90000 (1) | A | $3.4958 | 48282605 | I | See Footnote (4) |
Class A Common Stock | 5/18/2023 | | P | | 90000 (2) | A | $3.2999 | 48372605 | I | See Footnote (4) |
Class A Common Stock | 5/19/2023 | | P | | 90000 (3) | A | $3.4958 | 48462605 | I | See Footnote (4) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Explanation of Responses: |
(1) | Includes (i) 69,434 shares of Common Stock directly acquired by CPF III PT SPV, LLC ("SPV III") and (ii) 20,566 shares of Common Stock directly acquired by CPF III PT SPV-A, LLC ("SPV-A III"). |
(2) | Includes (i) 69,434 shares of Common Stock directly acquired by SPV III, and (ii) 20,566 shares of Common Stock directly acquired by SPV III-A. |
(3) | Includes (i) 69,434 shares of Common Stock directly acquired by SPV III, and (ii) 20,566 shares of Common Stock directly acquired by SPV III-A. |
(4) | Chicago Pacific Founders UGP, III LLC ("UGP III") is the general partner of Chicago Founders GP III, LP ("GP III"), the general partner of each of SPV III and SPV III-A. As a result, UGP III has the power to vote and dispose of the Issuer's securities held by SPV III and SPV III-A (the "Underlying Securities"). Each of UGP III and GP III disclaims beneficial ownership for the amount in excess of their pecuniary interest in the Underlying Securities. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Chicago Pacific Founders UGP III, LLC 980 NORTH MICHIGAN AVENUE, SUITE 1998 CHICAGO, IL 60611 |
| X |
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Chicago Pacific Founders GP III, L.P. 980 NORTH MICHIGAN AVENUE, SUITE 1998 CHICAGO, IL 60611 |
| X |
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CPF III PT SPV, LLC 980 NORTH MICHIGAN AVENUE, SUITE 1998 CHICAGO, IL 60611 |
| X |
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CPF III-A PT SPV, LLC 980 NORTH MICHIGAN AVENUE, CHICAGO, IL 60611 |
| X |
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Signatures
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Chicago Pacific Founders UGP III, LLC, /s/ Michael Wilson, authorized signatory | | 5/19/2023 |
**Signature of Reporting Person | Date |
Chicago Pacific Founders GP III, L.P., /s/ Michael Wilson, authorized signatory | | 5/19/2023 |
**Signature of Reporting Person | Date |
CPF III PT SPV, LLC, /s/ Michael Wilson, authorized signatory | | 5/19/2023 |
**Signature of Reporting Person | Date |
CPF III-A PT SPV, LLC, /s/ Michael Wilson, authorized signatory | | 5/19/2023 |
**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). |
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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