0000899243-17-018948.txt : 20170726 0000899243-17-018948.hdr.sgml : 20170726 20170726121355 ACCESSION NUMBER: 0000899243-17-018948 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170726 FILED AS OF DATE: 20170726 DATE AS OF CHANGE: 20170726 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Adcock Scott CENTRAL INDEX KEY: 0001710673 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38163 FILM NUMBER: 17982081 MAIL ADDRESS: STREET 1: 500 EAST SHORE DR 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-07-26 0 0001668673 PetIQ, Inc. PETQ 0001710673 Adcock Scott 500 E. SHORE DRIVE, SUITE 120 EAGLE ID 83616 1 1 0 0 President Class B Common Stock 2017-07-26 4 D 0 66667 16.00 D 809574 I See Footnote Non-Qualified Stock Option (right to buy) 16.00 2017-07-26 4 A 0 205405 0.00 A Class A Common Stock 205405 205405 D The shares were repurchased by the Issuer. Shares are held by Adcock Ventures, LLC ("Ventures"). Mr. Adcock is the manager of Ventures and exercises voting and investment control over all shares held by Ventures. The options vest and become exercisable in four approximately equal installments on each of the first four anniversaries of July 20, 2017. The options terminate on the tenth anniversary of July 20, 2017. /s/ Robert Mooney, Attorney in Fact 2017-07-26