0000899243-17-018618.txt : 20170720 0000899243-17-018618.hdr.sgml : 20170720 20170720153850 ACCESSION NUMBER: 0000899243-17-018618 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20170720 FILED AS OF DATE: 20170720 DATE AS OF CHANGE: 20170720 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Clarke James Nathan CENTRAL INDEX KEY: 0001710881 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38163 FILM NUMBER: 17974325 MAIL ADDRESS: STREET 1: 500 EAST SHORE DRIVE STREET 2: SUITE 120 CITY: EAGLE STATE: ID ZIP: 83616 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PetIQ, Inc. CENTRAL INDEX KEY: 0001668673 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-DRUGS PROPRIETARIES & DRUGGISTS' SUNDRIES [5122] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: PETIQ LLC STREET 2: 500 E. SHORE DRIVE SUITE 120 CITY: EAGLE STATE: ID ZIP: 83616 BUSINESS PHONE: 208-939-8900 MAIL ADDRESS: STREET 1: PETIQ LLC STREET 2: 500 E. SHORE DRIVE SUITE 120 CITY: EAGLE STATE: ID ZIP: 83616 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2017-07-20 0 0001668673 PetIQ, Inc. PETQ 0001710881 Clarke James Nathan 500 E. SHORE DR., SUITE 120 EAGLE ID 83616 1 0 0 0 Class B Common Stock 0.00 Class A Common Stock 2509906 I See Footnotes The shares of Class B Common Stock are convertible for shares of the Issuer's Class A Common Stock as described under the heading "The Transactions - Exchange Rights" in the Issuer's registration statement on Form S-1 (File No. 333-218955) and have no expiration date. Includes 46,202 shares of Class B Common Stock held by Labore et Honore LLC TS F Series, 254,108 shares of Class B Common Stock held by Labore et Honore LLC TS E Series, 159,761 shares of Class B Common Stock held by Labore et Honore LLC TS Preferred Series, 95,467 shares of Class B Common Stock held by Labore et Honore LLC TS C Series, 263,355 shares of Class B common stock held by Labore et Honore LLC and 156,060 shares of Class B Common Stock held by Labore et Honore LLC TS Founders Series (collectively, the "Clarke Capital Entities"). Mr. Clarke is the manager of the Clarke Capital Entities, and has voting and investment control over and may be deemed to be the beneficial owner of shares of Class B Common Stock held by the Clarke Capital Entities. Includes 1,055,123 shares of Class B Common Stock held by The JNC 101 Trust of which Andrea Clarke, the wife of Mr. Clarke is the trustee, 239,916 shares of Class B Common Stock held by the James N. Clarke Irrevocable Trust, dated December 27, 2012 of which Mrs. Clarke is the trustee and 239,916 shares of Class B Common Stock held by the Andrea M. Clarke Irrevocable Trust, dated December 27, 2012 of which Mr. Clarke is the trustee. See Exhibit 24.1 - Power of Attorney. /s/ Robert Mooney, by power of attorney 2017-07-20 EX-24.1 2 attachment1.htm EX-24.1 DOCUMENT

                                POWER OF ATTORNEY
                              (Section 16 Filings)

        Know all by these presents that the undersigned hereby constitutes and
appoints each of Robert P.K. Mooney, John Newland and Patrick Jones, signing
singly, the undersigned's true and lawful attorney-in-fact to:

     1. Execute for and on behalf of the undersigned, in the undersigned's
        capacity as an officer, director or greater than 10% shareholder of
        PetIQ, Inc. ("PetIQ"), Forms 3, 4 and 5 in accordance with Section
        16(a) of the Securities Exchange Act of 1934 and the rules and
        regulations promulgated thereunder;

     2. Do and perform any and all acts for and on behalf of the undersigned
        which may be necessary or desirable to complete and execute any such
        Form 3, 4 or 5, complete and execute any amendment or amendments
        thereto and timely file such form with the United States Securities
        and Exchange Commission and any national quotation system, national
        securities exchange, stock exchange or similar authority; and

     3. Take any other action of any type whatsoever in connection with the
        foregoing which, in the opinion of such attorney-in-fact, may be of
        benefit to, in the best interest of or legally required by the
        undersigned, it being understood that the documents executed by such
        attorney-in-fact on behalf of the undersigned pursuant to this Power
        of Attorney shall be in such form and shall contain such terms and
        conditions as such attorney-in-fact may approve in such
        attorney-in-fact's discretion.

        The undersigned hereby grants to such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Power of Attorney and the rights and powers herein
granted. The undersigned acknowledges that the foregoing attorney-in-fact, in
serving in such capacity at the request of the undersigned, is not assuming, nor
is PetIQ assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934.

        This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued by PetIQ, unless
earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorney-in-fact.

        IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of this 28th day of June, 2017.

                                        /s/ James Clarke
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                                        Signature