0001493152-23-039167.txt : 20231102 0001493152-23-039167.hdr.sgml : 20231102 20231102165338 ACCESSION NUMBER: 0001493152-23-039167 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231031 FILED AS OF DATE: 20231102 DATE AS OF CHANGE: 20231102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Porter Kelly CENTRAL INDEX KEY: 0001951508 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38424 FILM NUMBER: 231373325 MAIL ADDRESS: STREET 1: 4042 PARK OAKS BLVD, SUITE 350 CITY: TAMPA STATE: FL ZIP: 33610 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Lazydays Holdings, Inc. CENTRAL INDEX KEY: 0001721741 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-AUTO DEALERS & GASOLINE STATIONS [5500] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4042 PARK OAKS BLVD STREET 2: SUITE 350 CITY: TAMPA STATE: FL ZIP: 33610 BUSINESS PHONE: 813-246-4999 MAIL ADDRESS: STREET 1: 4042 PARK OAKS BLVD STREET 2: SUITE 350 CITY: TAMPA STATE: FL ZIP: 33610 FORMER COMPANY: FORMER CONFORMED NAME: Andina II Holdco Corp. DATE OF NAME CHANGE: 20171103 4 1 ownership.xml X0508 4 2023-10-31 0 0001721741 Lazydays Holdings, Inc. LAZY 0001951508 Porter Kelly C/O LAZYDAYS HOLDINGS, INC., 4042 PARK OAKS BLVD, SUITE 350 TAMPA FL 33610 0 1 0 0 Chief Financial Officer 0 Common Stock 2023-10-31 4 M 0 18588 A 18588 D Common Stock 2023-10-31 4 F 0 4525 6.31 A 14063 D Restricted Stock Units 2023-10-31 4 M 0 18588 0 D Common Stock 18588 37174 D Each restricted stock unit represents a contingent right to receive one share of the Issuer's Common Stock. The restricted stock units vest as follows: 18,588 on October 31, 2023, 18,587 on October 31, 2024 and 18,587 on October 31, 2025. Represents net shares issued with 4,525 shares to cover taxes withheld. Exhibit 24 - Limited Power of Attorney /s/ Minola Hunt, Attorney-in-Fact for Kelly Porter 2023-11-02