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