0001179110-19-000308.txt : 20190103
0001179110-19-000308.hdr.sgml : 20190103
20190103173236
ACCESSION NUMBER: 0001179110-19-000308
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181231
FILED AS OF DATE: 20190103
DATE AS OF CHANGE: 20190103
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Santana Will
CENTRAL INDEX KEY: 0001727824
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38163
FILM NUMBER: 19507211
MAIL ADDRESS:
STREET 1: 500 E 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
edgar.xml
FORM 4 -
X0306
4
2018-12-31
0
0001668673
PetIQ, Inc.
PETQ
0001727824
Santana Will
923 BRIDGEWAY PLACE
EAGLE
ID
83616
1
1
0
0
Executive Vice President
Class A Common Stock
2018-12-31
4
C
0
40000
0
A
49400
I
See Footnote
Class B Common Stock
2018-12-31
4
C
0
40000
0
D
Class A Common Stock
40000
119683
I
See Footnote
Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the Reporting Person.
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.
Each share of Class B Common Stock is convertible into one share of Class A Common Stock at the option of the holder and has no expiration date.
/s/ Robert Mooney, Attorney in Fact
2019-01-03