0001209191-21-020960.txt : 20210316 0001209191-21-020960.hdr.sgml : 20210316 20210316173158 ACCESSION NUMBER: 0001209191-21-020960 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210315 FILED AS OF DATE: 20210316 DATE AS OF CHANGE: 20210316 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HARVEY ROBERT BURTON CENTRAL INDEX KEY: 0001738212 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38532 FILM NUMBER: 21747230 MAIL ADDRESS: STREET 1: 40 BURTON HILLS BOULEVARD, SUITE 415 CITY: NASHVILLE STATE: TN ZIP: 37215 FORMER NAME: FORMER CONFORMED NAME: BURTON ROBERT HARVEY DATE OF NAME CHANGE: 20180420 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: i3 Verticals, Inc. CENTRAL INDEX KEY: 0001728688 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 824052852 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: 40 BURTON HILLS BLVD. STREET 2: SUITE 415 CITY: NASHVILLE STATE: TN ZIP: 37215 BUSINESS PHONE: 800-203-7981 MAIL ADDRESS: STREET 1: 40 BURTON HILLS BLVD. STREET 2: SUITE 415 CITY: NASHVILLE STATE: TN ZIP: 37215 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-03-15 0 0001728688 i3 Verticals, Inc. IIIV 0001738212 HARVEY ROBERT BURTON 40 BURTON HILLS BLVD. SUITE 415 NASHVILLE TN 37215 1 0 0 0 Class A common stock, par value $0.0001 per share 2021-03-15 4 C 0 110000 A 110000 I By CCSD II, L.P. Class A common stock, par value $0.0001 per share 2021-03-15 4 C 0 76000 A 76000 I By Claritas Capital Specialty Debt Fund, LP Class A common stock, par value $0.0001 per share 2021-03-15 4 C 0 14000 A 14000 I By CF i3 Corporation Class A common stock, par value $0.0001 per share 2021-03-15 4 S 0 110000 32.83 D 0 I By CCSD II, L.P. Class A common stock, par value $0.0001 per share 2021-03-15 4 S 0 76000 32.83 D 0 I By Claritas Capital Specialty Debt Fund, LP Class A common stock, par value $0.0001 per share 2021-03-15 4 S 0 14000 32.83 D 0 I By CF i3 Corporation Class B common stock, par value $0.0001 per share 2021-03-15 4 J 0 110000 D 41910 I By CCSD II, L.P. Class B common stock, par value $0.0001 per share 2021-03-15 4 J 0 76000 D 28012 I By Claritas Capital Specialty Debt Fund, LP Class B common stock, par value $0.0001 per share 2021-03-15 4 J 0 14000 D 4687 I By CF i3 Corporation Class B common stock, par value $0.0001 per share 11716 D Common Units 2021-03-15 4 C 0 110000 D Class A common stock, par value $0.0001 per share 110000 41910 I By CCSD II, L.P. Common Units 2021-03-15 4 C 0 76000 D Class A common stock, par value $0.0001 per share 76000 28012 I By Claritas Capital Specialty Debt Fund, LP Common Units 2021-03-15 4 C 0 14000 D Class A common stock, par value $0.0001 per share 14000 4687 I By CF i3 Corporation Common Units Class A common stock, par value $0.0001 per share 11716 11716 D Represents shares of Class A common stock, par value $0.0001 per share ("Class A Common Stock") of i3 Verticals, Inc. (the "Issuer") that were obtained upon a redemption of an equal number of common units in i3 Verticals, LLC (the "Common Units"). Represents shares of Class A Common Stock held by CCSD II, L.P. ("CCSD"), of which the Reporting Person serves as a voting member of the investment committee. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. Represents shares of Class A Common Stock held by Claritas Capital Specialty Debt Fund, L.P. ("Claritas"), of which the Reporting Person serves as a voting member of the investment committee. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. Represents shares of Class A Common Stock held by CF i3 Corporation ("CF"), of which the Reporting Person serves as an officer. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. Pursuant to the Amended and Restated Certificate of Incorporation of the Issuer, the shares of the Issuer's Class B common stock, par value $0.0001 per share ("Class B Common Stock") are cancelled for no consideration on a one-to-one basis upon redemption of the Common Units for shares of Class A Common Stock of the Issuer. Represents shares of Class B Common Stock held by CCSD. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. Represents shares of Class B Common Stock held by Claritas. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. Represents shares of Class B Common Stock held by CF. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. The Common Units may be redeemed by the holder at any time for an equal number of shares of Class A Common Stock or, at the election of i3 Verticals, LLC, cash equal to the volume-weighted average market price of such shares. Upon the redemption of a Common Unit for Class A Common Stock, any corresponding share of Class B Common Stock will be cancelled. The Common Units have no expiration date. Represents Common Units held by CCSD. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. Represents Common Units held by Claritas. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. Represents Common Units held by CF. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. /s/ Paul Maple, Attorney-in-Fact for Robert Burton Harvey 2021-03-16