0001793659-23-000002.txt : 20230210 0001793659-23-000002.hdr.sgml : 20230210 20230210185218 ACCESSION NUMBER: 0001793659-23-000002 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221231 FILED AS OF DATE: 20230210 DATE AS OF CHANGE: 20230210 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BLUHM NEIL CENTRAL INDEX KEY: 0001373161 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39232 FILM NUMBER: 23614057 MAIL ADDRESS: STREET 1: 900 NORTH MICHIGAN AVENUE STREET 2: SUITE 1900 CITY: CHICAGO STATE: IL ZIP: 60611 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NGB 2013 GRANDCHILDREN'S DYNASTY TRUST CENTRAL INDEX KEY: 0001839329 STATE OF INCORPORATION: IL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39232 FILM NUMBER: 23614056 BUSINESS ADDRESS: STREET 1: 900 N. MICHIGAN AVENUE, SUITE 1600 CITY: CHICAGO STATE: IL ZIP: 60611 BUSINESS PHONE: (312) 915 1086 MAIL ADDRESS: STREET 1: 900 N. MICHIGAN AVENUE, SUITE 1600 CITY: CHICAGO STATE: IL ZIP: 60611 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Rush Street Interactive, Inc. CENTRAL INDEX KEY: 0001793659 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS AMUSEMENT & RECREATION [7990] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 900 N. MICHIGAN AVENUE, SUITE 950 CITY: CHICAGO STATE: IL ZIP: 60611 BUSINESS PHONE: 773-893-5855 MAIL ADDRESS: STREET 1: 900 N. MICHIGAN AVENUE, SUITE 950 CITY: CHICAGO STATE: IL ZIP: 60611 FORMER COMPANY: FORMER CONFORMED NAME: dMY Technology Group, Inc. DATE OF NAME CHANGE: 20191108 5 1 wf-form5_167607311838409.xml FORM 5 X0306 5 2022-12-31 0 0 0 0001793659 Rush Street Interactive, Inc. RSI 0001373161 BLUHM NEIL C/O RUSH STREET INTERACTIVE, INC. 900 N. MICHIGAN AVENUE, SUITE 950 CHICAGO IL 60611 1 1 1 0 Executive Chairman 0001839329 NGB 2013 GRANDCHILDREN'S DYNASTY TRUST C/O RUSH STREET INTERACTIVE, INC. 900 N. MICHIGAN AVENUE, SUITE 950 CHICAGO IL 60611 1 0 1 0 Class V Voting Stock 2022-09-28 5 G 0 10000 0 D 107511780 I By NGB 2013 Grandchildren's Dynasty Trust Class V Voting Stock 2022-11-11 5 G 0 100000 0 D 107411780 I By NGB 2013 Grandchildren's Dynasty Trust Class V Voting Stock 1362663 I By Rush Street Interactive GP, LLC Class V Voting Stock 1527334 I By NGB 2016 Revocable Trust Class A Common Units of Rush Street Interactive, L.P. 2022-09-28 5 G 0 10000 0 D Class A Common Stock 10000.0 107511780 I By NGB 2013 Grandchildren's Dynasty Trust Class A Common Units of Rush Street Interactive, L.P. 2022-11-11 5 G 0 100000 0 D Class A Common Stock 100000.0 107411780 I By NGB 2013 Grandchildren's Dynasty Trust Class A Common Units of Rush Street Interactive, L.P. Class A Common Stock 1362663.0 1362663 I By Rush Street Interactive GP, LLC Class A Common Units of Rush Street Interactive, L.P. Class A Common Stock 1527334.0 1527334 I By NGB 2016 Revocable Trust Represents a bona fide charitable gift of the Issuer's Class V Voting Stock from the Reporting Person to a donor-advised fund. These securities are held by NGB 2013 Grandchildren's Dynasty Trust (the "NGB Dynasty Trust"). The Reporting Person is the grantor and trustee of NGB Dynasty Trust and exercises sole voting and investment control over the securities held thereby. The Reporting Person may be deemed to be the beneficial owner of securities held by the NGB Dynasty Trust to the extent that he or his immediate family members are beneficiaries of such trust. These securities are held by Rush Street Interactive GP, LLC (the "RSI GP"). The Reporting Person is a manager of RSI GP and exercises sole voting and investment control over, and may be deemed to have an indirect beneficial ownership with respect to, the securities held thereby. These securities are held by the NGB 2016 Revocable Trust (the "NGB Revocable Trust"). The Reporting Person is the grantor, sole trustee and sole beneficiary of the NGB Revocable Trust. Pursuant to the Amended and Restated Limited Partnership Agreement of Rush Street Interactive, L.P. ("RSI LP"), beginning on June 29, 2021, the Class A Common Units of RSI LP beneficially owned by the Reporting Person may be exchanged, subject to certain conditions, for one share of Class A Common Stock of the Issuer. Upon such exchange, an equivalent number of shares of Class V Voting Stock then held by the reporting person will be canceled. Neil Bluhm: /s/ Kyle Sauers as Attorney-in-fact 2023-02-10 NGB 2013 Grandchildren's Dynasty Trust: /s/ Kyle Sauers as Attorney-in-fact 2023-02-10