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*
Santana Will

(Last) (First) (Middle)
500 E. SHORE DR
SUITE 120

(Street)
EAGLE ID 83616

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/17/2018
3. Issuer Name and Ticker or Trading Symbol
PetIQ, Inc. [ PETQ ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Executive Vice President
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)
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
Class B Common Stock (1) (1) Class A Common Stock(2) 2,100,000(2) $0 I See Footnote(3)
Employee Stock Option (Right to Buy) (4) 01/05/2028 Class A Common Stock 100,000(5) $21.37 D
Explanation of Responses:
1. The shares of Class B Common Stock are convertible (along with an equal number of common units of PetIQ Holdings, LLC) for shares of the Issuer's Class A Common Stock as described under the heading "The Transactions - Exchange Rights" in the Issuers registration statement on Form S-1 (File No. 333-218955) and have no expiration date.
2. Mr. Santana, indirectly through his ownership of 50% of the outstanding stock of VIP Petcare Holdings, Inc., was initially issued 66,666.5 shares of the Class B Common Stock, and PetIQ, Inc. will issue the remaining 2,033,333.5 shares as promptly as practicable for no additional consideration.
3. The shares of Class B Common Stock are held by VIP Petcare Holdings, Inc. Mr. Santana holds 50% of the equity interests of VIP Petcare Holdings, Inc.
4. The options will vest quarterly on each of the first four anniversaries of January 17, 2018.
5. Granted under the PetIQ, Inc. 2018 Inducement and Retention Stock Plan for CVC Employees
Remarks:
See Exhibit 24.1 - Power of Attorney
/s/ Robert Mooney, by power of attorney 01/29/2018
** 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.