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