SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
JCIC Sponsor LLC

(Last) (First) (Middle)
C/O JACK CREEK INVESTMENT CORP.,
386 PARK AVENUE SOUTH, FL 20

(Street)
NEW YORK NY 10016

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Jack Creek Investment Corp. [ JCIC ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
03/08/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Ordinary Shares, par value $0.0001 per share (2) 03/08/2021 S 25,000(2) (2) (2) Class A Ordinary Shares, par value $0.0001 per share 25,000 $0.0029(2) 8,550,000 I See footnotes(1)(3)(4)
1. Name and Address of Reporting Person*
JCIC Sponsor LLC

(Last) (First) (Middle)
C/O JACK CREEK INVESTMENT CORP.,
386 PARK AVENUE SOUTH, FL 20

(Street)
NEW YORK NY 10016

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
KSH Capital LP

(Last) (First) (Middle)
C/O JACK CREEK INVESTMENT CORP.,
386 PARK AVENUE SOUTH, FL 20

(Street)
NEW YORK NY 10016

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
Manager
1. Name and Address of Reporting Person*
KELTER JEFFREY E

(Last) (First) (Middle)
C/O JACK CREEK INVESTMENT CORP.,
386 PARK AVENUE SOUTH, FL 20

(Street)
NEW YORK NY 10016

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
SAVAGE ROBERT F JR

(Last) (First) (Middle)
C/O JACK CREEK INVESTMENT CORP.,
386 PARK AVENUE SOUTH, FL 20

(Street)
NEW YORK NY 10016

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
1. Name and Address of Reporting Person*
JERMOLUK THOMAS

(Last) (First) (Middle)
C/O JACK CREEK INVESTMENT CORP.,
386 PARK AVENUE SOUTH, FL 20

(Street)
NEW YORK NY 10016

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. This form is being filed by the following Reporting Persons: JCIC Sponsor LLC (the "Sponsor"), KSH Capital LP ("KSH Capital"), Jeffrey E. Kelter, Robert F. Savage and Thomas Jermoluk. Because of the relationships among the Reporting Persons, the Reporting Persons may be deemed to beneficially own the securities reported herein to the extent of their respective pecuniary interests. Each Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of such Reporting Person's pecuniary interest therein, if any.
2. Sponsor sold 25,000 shares of Class B ordinary shares, par value $0.0001 per share (the "Class B Ordinary Shares") for the aggregate consideration of $72.46. Class B Ordinary Shares have no expiration date and are convertible into Class A ordinary shares, par value $0.0001 per share, of the Issuer, as described under the heading "Description of Securities-founder shares" in the Issuer's registration statement on Form S-1 (File No. 333-248951).
3. The manager of the Sponsor is KSH Capital. Each of Jeffrey E. Kelter, Robert F. Savage and Thomas Jermoluk indirectly own an approximately 30% interest in Sponsor and, pursuant to the Sponsor's operating agreement, through their investment vehicles have a consent right over the Sponsor's investments, including voting and investment discretion with respect to the Class B Ordinary Shares held of record by the Sponsor.
4. Pursuant to Rule 16a-1(a)(4) under the Exchange Act, this filing shall not be deemed an admission that the Reporting Persons are, for purposes of Section 16 of the Exchange Act or otherwise, the beneficial owners of any equity securities in excess of their respective pecuniary interests.
Remarks:
/s/ Robert Savage, JCIC Sponsor LLC, By its Manager, KSH CAPITAL LP, Acting by its General Partner, KSH CAPITAL GP LLC, Robert Savage, President 03/08/2021
* KSH Capital LP 03/08/2021
* Jeffrey E. Kelter 03/08/2021
* Robert F. Savage 03/08/2021
* Thomas Jermoluk 03/08/2021
*By: /s/ Lauren Ores, Attorney-in-Fact 03/08/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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