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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
LLC Units in Xponential Holdings LLC | (3) | 07/26/2021 | A | 12,623,677 (1) | (4) | (4) | Class A Common Stock | 12,623,677 | $ 0 | 12,623,677 | I | H&W Investco LP (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Grabowski Mark C/O XPONENTIAL FITNESS, INC. 17877 VON KARMAN AVE, SUITE 100 IRVINE, CA 92614 |
X | X | ||
H&W INVESTCO LP 781 BOSTON POST RD #1313 MADISON, CT 06443 |
X | X | ||
H&W Investco II LP 781 BOSTON POST RD #1313 MADISON, CT 06443 |
X | X | ||
MGAG LLC 781 BOSTON POST RD #1313 MADISON, CT 06443 |
X | X |
/s/ Mark Grabowski | 07/28/2021 | |
**Signature of Reporting Person | Date | |
/s/ H&W Investco LP, By: Mark Graboski, its Authorized Signatory | 07/28/2021 | |
**Signature of Reporting Person | Date | |
/s/ H&W Investco II LP, By: Mark Grabowski, its Authorized Signatory | 07/28/2021 | |
**Signature of Reporting Person | Date | |
/s/ MGAG LLC, By: Mark Grabowski, its Authorized Signatory | 07/28/2021 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | These securities were acquired through the conversion prior to the completion of the Issuer's initial public offering of historical interests held by the reporting persons and their affiliates in H&W Franchise Holdings, LLC. |
(2) | MGAG LLC is the general partner of H&W Investco LP and H&W Investco II LP. Mr. Grabowski is the sole manager of MGAG LLC and, through a wholly owned disregarded entity, the controlling member of MGAG LLC. |
(3) | Upon vesting, each LLC unit in Xponential Holdings LLC ("LLC Unit") may be redeemed for, together with the cancellation of a share of Class B common stock, one share of Class A common stock or a cash payment equal to the volume weighted average market price of one share of Class A common stock for each LLC Unit redeemed. The LLC Units do not expire. |
(4) | The LLC Units are fully vested. |