0001567619-21-020010.txt : 20211112 0001567619-21-020010.hdr.sgml : 20211112 20211112160600 ACCESSION NUMBER: 0001567619-21-020010 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211109 FILED AS OF DATE: 20211112 DATE AS OF CHANGE: 20211112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GRAYSON CHELSEA A CENTRAL INDEX KEY: 0001628264 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40638 FILM NUMBER: 211403393 MAIL ADDRESS: STREET 1: 1116 SOUTH RIDGELEY DRIVE CITY: LOS ANGELES STATE: CA ZIP: 90019 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Xponential Fitness, Inc. CENTRAL INDEX KEY: 0001802156 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS AMUSEMENT & RECREATION [7990] IRS NUMBER: 844395129 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 17877 VON KARMAN AVE STREET 2: SUITE 100 CITY: IRVINE STATE: CA ZIP: 92614 BUSINESS PHONE: 6507522078 MAIL ADDRESS: STREET 1: 17877 VON KARMAN AVE STREET 2: SUITE 100 CITY: IRVINE STATE: CA ZIP: 92614 4 1 doc1.xml FORM 4 X0306 4 2021-11-09 0 0001802156 Xponential Fitness, Inc. XPOF 0001628264 GRAYSON CHELSEA A C/O XPONENTIAL FITNESS, INC. 17877 VON KARMAN AVE, SUITE 100 IRVINE CA 92614 1 0 0 0 Class A Common Stock 2021-11-09 4 A 0 4635 0 A 4635 D Represents the Issuer's Class A common stock subject to restricted stock units (RSUs) award granted to the Reporting Person for services on the Issuer's board of directors. The RSUs will vest, subject to continued service, 100% on October 21, 2022. /s/ John Meloun, as Attorney-in-Fact, for Chelsea Grayson 2021-11-11