SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Green Jonathan

(Last) (First) (Middle)
C/O WAITR HOLDINGS INC.
844 RYAN STREET, SUITE 300

(Street)
LAKE CHARLES LA 70601

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/15/2018
3. Issuer Name and Ticker or Trading Symbol
Waitr Holdings Inc. [ WTRH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 54,109 I See footnote(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Warrants (2) (2) Common Stock 374,291 (2) I See footnote(1)
Explanation of Responses:
1. Securities held directly by Lugard Road Master Capital Master Fund (""Lugard Road Master""). The Reporting Person is a managing member and controlling person of Lugard Road Capital GP, LLC, the general partner of Lugard Road Master, and therefore may be deemed to beneficially own the securities held by Lugard Road Master. Mr. Green disclaims any beneficial ownership of the reported shares other than to the extent of any pecuniary interest he may have therein, directly or indirectly.
2. Each warrant is exercisable at any time for one-half of one share of the Issuer's common stock at a price of $5.75 per one-half share ($11.50 per whole share) and expires November 15, 2023.
Remarks:
See Exhibit 24.1 - Power of Attorney
/s/ Joel L. Rubinstein, Attorney-in-Fact 11/19/2018
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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