0001593968-19-000819.txt : 20190319
0001593968-19-000819.hdr.sgml : 20190319
20190319190257
ACCESSION NUMBER: 0001593968-19-000819
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20190315
FILED AS OF DATE: 20190319
DATE AS OF CHANGE: 20190319
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BIRD LARRY R
CENTRAL INDEX KEY: 0001734842
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38163
FILM NUMBER: 19693164
MAIL ADDRESS:
STREET 1: C/O PETIQ, INC., 500 E. 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
4
1
primary_01.xml
PRIMARY DOCUMENT
X0306
4
2019-03-15
0001668673
PetIQ, Inc.
PETQ
0001734842
BIRD LARRY R
923 S BRIDGE WAY PL
EAGLE
ID
83616-6885
true
false
false
false
Class A Common Stock
2019-03-15
4
M
false
667
27.94
A
667
D
Class A Common Stock
2019-03-15
4
F
false
298
27.94
D
369
D
Restricted Stock Unit
2019-03-15
4
M
false
667
27.94
D
Class A Common Stock
667
1335
D
Settlement of restricted stock units ("RSU") into shares of Class A common stock.
Shares withheld to satisfy minimum tax withholding requirements upon vesting of RSUs.
Each RSU represents a contingent right to receive one share of Class A Common Stock.
The RSUs vest and settle in stock or cash in three approximately equal installments on each of the first three anniversaries of March 15, 2018.
/s/ R. Michael Herrman, as attorney-in-fact
2019-03-19
EX-24
2
bird_poa.txt
EX-24 DOCUMENT
POWER OF ATTORNEY
(Section 16 Filings)
Know all by these presents that the undersigned hereby constitutes and
appoints each of R. Michael Herrman, 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"), Forms3, 4 and 5 in accordance with Section16(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 Form3,
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 Section16 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 Forms3, 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 5th day of March, 2019
/s/ Larry R. Bird
Name: Larry R. Bird