0001415889-24-011076.txt : 20240417 0001415889-24-011076.hdr.sgml : 20240417 20240417203238 ACCESSION NUMBER: 0001415889-24-011076 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240417 FILED AS OF DATE: 20240417 DATE AS OF CHANGE: 20240417 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CLARK JAMES H CENTRAL INDEX KEY: 0001008700 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-42018 FILM NUMBER: 24852596 MAIL ADDRESS: STREET 1: C/O MYCFO INC STREET 2: PO BOX 10196 CITY: PALO ALTO STATE: CA ZIP: 94303 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Clark Jermoluk Founders Fund I LLC CENTRAL INDEX KEY: 0002019348 ORGANIZATION NAME: STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-42018 FILM NUMBER: 24852597 BUSINESS ADDRESS: STREET 1: C/O L. CPA, EISNERAMPER ADVISORY GROUP STREET 2: 505 S. FLAGER DRIVE, SUITE 900 CITY: WEST PALM BEACH STATE: FL ZIP: 33401 BUSINESS PHONE: 561-803-4623 MAIL ADDRESS: STREET 1: C/O L. CPA, EISNERAMPER ADVISORY GROUP STREET 2: 505 S. FLAGER DRIVE, SUITE 900 CITY: WEST PALM BEACH STATE: FL ZIP: 33401 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Ibotta, Inc. CENTRAL INDEX KEY: 0001538379 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-ADVERTISING [7310] ORGANIZATION NAME: 07 Trade & Services IRS NUMBER: 352426358 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1801 CALIFORNIA STREET, SUITE 400 CITY: DENVER STATE: CO ZIP: 80202 BUSINESS PHONE: 303-593-1633 MAIL ADDRESS: STREET 1: 1801 CALIFORNIA STREET, SUITE 400 CITY: DENVER STATE: CO ZIP: 80202 FORMER COMPANY: FORMER CONFORMED NAME: Zing Enterprises, Inc. DATE OF NAME CHANGE: 20111228 3 1 form3-04182024_120432.xml X0206 3 2024-04-17 0 0001538379 Ibotta, Inc. IBTA 0002019348 Clark Jermoluk Founders Fund I LLC EISNERAMPER ADVISORY GROUP, LLC 505 S. FLAGER DR. SUITE 900 WEST PALM BEACH FL 33401 false false true false 0001008700 CLARK JAMES H EISNERAMPER ADVISORY GROUP, LLC 505 S. FLAGER DR. SUITE 900 WEST PALM BEACH FL 33401 0 0 1 0 Series B Preferred Stock Common Stock 3520804 D Series C Preferred Stock Common Stock 1862545 D Series C-1 Preferred Stock Common Stock 379108 D Each share of Series B Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock (the "IPO") and has no expiration date. Each share of Common Stock shall be reclassified into one share of Class A Common Stock immediately prior to the completion of the IPO. The shares are held by Clark Jermoluk Founders Fund I LLC, which is 95% owned by the JHC Family 2016 Trust (the "JHC Trust"). The JHC Trust is an entity controlled by James H. Clark. Each share of Series C Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the IPO and has no expiration date. Each share of Series C-1 Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the IPO and has no expiration date. /s/ James H. Clark 2024-04-17