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
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1. Name and Address of Reporting Person*
Bogdanov Leo

(Last) (First) (Middle)
C/O WAITR HOLDINGS INC.
214 JEFFERSON STREET, SUITE 200

(Street)
LAFAYETTE LA 70501

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/22/2020
3. Issuer Name and Ticker or Trading Symbol
Waitr Holdings Inc. [ WTRH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
See Remarks
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 10,000 D
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
Restricted Stock Units (1) (1) Common Stock 128,206 (1) D
Restricted Stock Units (2) (2) Common Stock 121,794 (2) D
Explanation of Responses:
1. Each Restricted Stock Unit ("RSU") represents a contingent right to receive one share of common stock of Waitr Holdings Inc. (the "Company") or an equivalent amount in cash (or partly in cash and partly in shares). One-third of the RSUs shall vest each year over the course of three years, pursuant to the Restricted Stock Unit Award Agreement entered into by the Reporting Person as of August 29, 2019 (the "Grant Date"), beginning on the first anniversary of the Grant Date, subject to the Reporting Person's continued employment with the Company through the applicable vesting date, provided that the RSUs shall fully vest in the event of a Change of Control (as defined in the Waitr Holdings Inc. 2018 Omnibus Incentive Plan (the "Plan")).
2. Each RSU represents a contingent right to receive one share of common stock of the Company or an equivalent amount in cash (or partly in cash and partly in shares). One-third of the RSUs shall vest each year over the course of three years pursuant to a Restricted Stock Unit Award Agreement to be entered into by the Reporting Person, subject to the Reporting Person's continued employment with the Company through the applicable vesting date, provided that the RSUs shall fully vest in the event of a Change of Control (as defined in the Plan).
Remarks:
Chief Financial Officer Chief Accounting Officer See Exhibit 24.1 - Power of Attorney - Filed herewith.
/s/ Roman Ibragimov, Attorney-in-Fact 05/27/2020
** 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.
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