0001209191-20-051597.txt : 20200922
0001209191-20-051597.hdr.sgml : 20200922
20200922204253
ACCESSION NUMBER: 0001209191-20-051597
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20200922
FILED AS OF DATE: 20200922
DATE AS OF CHANGE: 20200922
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Pham Luan
CENTRAL INDEX KEY: 0001819373
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39537
FILM NUMBER: 201190717
MAIL ADDRESS:
STREET 1: C/O LAIRD SUPERFOOD, INC.
STREET 2: 275 W. LUNDGREN MILL DRIVE
CITY: SISTERS
STATE: OR
ZIP: 97759
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Laird Superfood, Inc.
CENTRAL INDEX KEY: 0001650696
STANDARD INDUSTRIAL CLASSIFICATION: FOOD & KINDRED PRODUCTS [2000]
IRS NUMBER: 474373641
STATE OF INCORPORATION: OR
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 275 W. LUNDGREN MILL DR.
CITY: SISTERS
STATE: OR
ZIP: 97759
BUSINESS PHONE: (541) 548-0577
MAIL ADDRESS:
STREET 1: 275 W. LUNDGREN MILL DR.
CITY: SISTERS
STATE: OR
ZIP: 97759
FORMER COMPANY:
FORMER CONFORMED NAME: Laird Superfood, LLC
DATE OF NAME CHANGE: 20150811
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2020-09-22
0
0001650696
Laird Superfood, Inc.
LSF
0001819373
Pham Luan
C/O LAIRD SUPERFOOD
275 W LUNDGREN MILL DR
SISTERS
OR
97759
0
1
0
0
CRMO
Common Stock
120114
D
Stock Option (right to buy)
2.00
2026-02-23
Common Stock
20000
D
Series A-1 Preferred Stock
Common Stock
4000
D
Stock Option (right to buy)
7.50
2018-01-25
2028-01-24
Common Stock
5000
D
Stock Option (right to buy)
12.315
2029-05-07
Common Stock
26666
D
Stock Option (right to buy)
12.315
2029-05-07
Common Stock
9584
D
Stock Option (right to buy)
13.05
2030-05-31
Common Stock
4024
D
Stock option granted under the 2016 Stock Incentive Plan ("Stock Plan") on February 24, 2016 and became exercisable with respect to 25% of the shares of common stock on each of the four anniversaries of the date of grant.
Each share of Laird Superfood, Inc. (the "Company") Series A-1 Preferred Stock is convertible on a one-to-two basis into shares of the Company's common stock at the holder's election and has no expiration date. The Series A-1 Preferred Stock will automatically convert into common stock upon the closing of the Company's initial public offering.
Stock option granted under the 2018 Equity Incentive Plan ("Equity Plan") on May 8, 2019 and became exercisable with respect to approximately 50% of the shares of common stock on June 1, 2019 and June 1, 2020.
Stock option to purchase 53,334 shares of common stock granted under the Equity Plan on May 8, 2019. The options vest in six installments based on the achievement by the Company of certain performance criteria concerning monthly revenue benchmarks. The performance criteria for the first installment were met on December 1, 2019, resulting in vesting of the options as to 4,792 shares of common stock. The options will vest as to an additional 4,792 shares of common stock one year after the performance criteria for first installment were met, and there will be four installments that will vest upon the satisfaction of additional criteria.
Stock option granted under the Equity Plan on June 1, 2020 and becomes exercisable with respect to 25% of the shares of common stock on each of the first four anniversaries of the date of grant.
/s/ Andrew McCormick, as attorney-in-fact for Luan Pham
2020-09-22
EX-24.3_938233
2
poa.txt
POA DOCUMENT
Limited Power of Attorney Section 16 Reporting Obligations
Power of Attorney
Know all by these presents, that the undersigned hereby makes, constitutes and
appoints each of Valerie Ells, Andrew McCormick and Kim Ausk, or any of them
acting singly, and with full power of substitution and re-substitution, the
undersigneds true and lawful attorney in fact (each of such persons and their
substitutes being referred to herein as the "Attorney-in-Fact"), with full power
to act for the undersigned and in the undersigneds name, place and stead, in any
and all capacities, to:
1. Prepare, execute, and submit to the Securities and Exchange Commission
("SEC") a Form ID, including amendments thereto, and any other documents
necessary or appropriate to obtain codes and passwords enabling the undersigned
to make electronic filings with the SEC of reports required or considered by the
Attorney-in-Fact to be advisable under Section 16 of the Securities Exchange Act
of 1934 (the "Exchange Act") or any rule or regulation of the SEC;
2. Prepare, execute and submit to the SEC, Laird Superfood, Inc. (the
"Company"), and/or any national securities exchange on which the Companys
securities are listed any and all reports (including any amendments thereto) the
undersigned is required to file with the SEC, or which the Attorney-in-Fact
considers it advisable to file with the SEC, under Section 16 of the Exchange
Act or any rule or regulation thereunder, or under Rule 144 under the Securities
Act of 1933 ("Rule 144"), with respect to the any security of the Company,
including Forms 3, 4 and 5 and Forms 144; and
3. Obtain, as the undersigneds representative and on the undersigneds behalf,
information regarding transactions in the Companys equity securities from any
third party, including the Company and any brokers, dealers, employee benefit
plan administrators and trustees, and the undersigned hereby authorizes any such
third party to release any such information to the Attorney-in-Fact.
The undersigned acknowledges that:
a) This Power of Attorney authorizes, but does not require, the Attorney-in-Fact
to act in his or her discretion on information provided to such Attorney-in-Fact
without independent verification of such information;
b) Any documents prepared or executed by the Attorney-in-Fact on behalf of the
undersigned pursuant to this Power of Attorney will be in such form and will
contain such information as the Attorney-in-Fact, in his or her discretion,
deems necessary or desirable;
c) Neither the Company nor the Attorney-in-Fact assumes any liability for the
undersigneds responsibility to comply with the requirements of Section 16 of the
Exchange Act or Rule 144, any liability of the undersigned for any failure to
comply with such requirements, or any liability of the undersigned for
disgorgement of profits under Section 16(b) of the Exchange Act; and
d) This Power of Attorney does not relieve the undersigned from responsibility
for compliance with the undersigneds obligations under Section 16 of the
Exchange Act, including, without limitation, the reporting requirements under
Section 16 of the Exchange Act.
The undersigned hereby grants to the Attorney-in-Fact full power and authority
to do and perform each and every act and thing requisite, necessary or advisable
to be done in connection with the foregoing, as fully, to all intents and
purposes, as the undersigned might or could do in person, hereby ratifying and
confirming all that the Attorney-in-Fact, or his or her substitute or
substitutes, shall lawfully do or cause to be done by authority of this Power of
Attorney.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 4 or 5 or Forms 144 with respect
to the undersigneds holdings of and transactions in securities of the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
Attorney-in-Fact. This Power of Attorney revokes all previous powers of attorney
with respect to the subject matter of this Power of Attorney.
IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney as of
July 17, 2020.
Signature /s/Luan Pham
Print Name Luan Pham