0001593968-19-000906.txt : 20190402 0001593968-19-000906.hdr.sgml : 20190402 20190402191131 ACCESSION NUMBER: 0001593968-19-000906 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190329 FILED AS OF DATE: 20190402 DATE AS OF CHANGE: 20190402 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: 19726997 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 primary_01.xml PRIMARY DOCUMENT X0306 4 2019-03-29 0001668673 PetIQ, Inc. PETQ 0001727824 Santana Will 923 BRIDGE WAY PL EAGLE ID 83616 true true false false Executive Vice President Class A Common Stock 2019-03-29 4 C false 40000 0 A 40000 I See Footnote Class B Common Stock 2019-03-29 4 C false 40000 0 D Class A Common Stock 40000 1076833 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 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. 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. /s/ R. Michael Herrman, as attorney-in-fact 2019-04-02