3: Initial statement of beneficial ownership of securities
Published on April 17, 2024
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIESFiled 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 04/17/2024 |
3. Issuer Name and Ticker or Trading Symbol
Ibotta, Inc. [ IBTA ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
|---|---|---|---|
| Common Stock(1) | 95,767(2) | D |
| 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
|---|---|---|---|---|---|---|---|
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Employee Stock Option (Right to Buy) | (3) | 02/04/2030 | Common Stock(1) | 5,000 | 12.75 | D | |
| Employee Stock Option (Right to Buy) | (4) | 05/05/2030 | Common Stock(1) | 625 | 6.55 | D | |
| Employee Stock Option (Right to Buy) | (5) | 12/08/2030 | Common Stock(1) | 8,198 | 8.3 | D | |
| Employee Stock Option (Right to Buy) | (6) | 07/15/2031 | Common Stock(1) | 47,775 | 22.2 | D | |
| Employee Stock Option (Right to Buy) | (7) | 08/03/2031 | Common Stock(1) | 20,000 | 22.2 | D | |
| Employee Stock Option (Right to Buy) | (8) | 08/02/2032 | Common Stock(1) | 5,000 | 19.25 | D | |
| Employee Stock Option (Right to Buy) | (9) | 03/07/2033 | Common Stock(1) | 3,647 | 10.4 | D | |
| Employee Stock Option (Right to Buy) | (10) | 12/05/2033 | Common Stock(1) | 82,500 | 25.64 | D | |
| Explanation of Responses: |
| 1. Each share of Common Stock shall be reclassified into one share of Class A Common Stock immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock. |
| 2. Certain of these securities are restricted stock units (RSUs). Each RSU represents a contingent right to receive one share of the Issuer's Common Stock, subject to the applicable vesting schedule and conditions. |
| 3. All of the shares subject to the option are fully vested and exercisable as of the date hereof. |
| 4. This option, originally for 15,000 shares, vested as to 1/48th of the shares subject to the option vested on June 5, 2020 and 1/48th of the shares vest monthly thereafter, subject to the Reporting Person's continued service through each vesting date. |
| 5. This option, originally for 30,000 shares, vested as to 1/48th of the shares on January 8, 2021 and 1/48th of the shares vest monthly thereafter, subject to the Reporting Person's continued service through each vesting date. |
| 6. 1/48th of the shares subject to the option vested on August 15, 2021 and 1/48th of the shares vest monthly thereafter, subject to the Reporting Person's continued service through each vesting date. |
| 7. The shares subject to this option become eligible to vest ("Eligible Shares") upon the extension of certain key business agreements. In order for any Eligible Shares to vest, the Reporting Person must remain continuously employed through April 1 following the fiscal year in which the goal is achieved. In addition, if there is a change in control by certain Ibotta Performance Network ("IPN") partners, then 50% of the shares subject to this option will immediately vest, and the remaining portion of this option will immediately terminate and be cancelled. |
| 8. 1/36th of the shares subject to the option vested on February 3, 2022 and 1/36th of the shares vest monthly thereafter, subject to the Reporting Person's continued service through each vesting date. |
| 9. This option, originally for 5,000 shares, vested as to 1/48th of the shares on February 16, 2023 and 1/48th of the shares vest monthly thereafter, subject to the Reporting Person's continued service through each vesting date. |
| 10. 1/48th of the shares subject to the option vested on December 10, 2023 and 1/48th of the shares vest monthly thereafter, subject to the Reporting Person's continued service through each vesting date. |
| Remarks: |
| Exhibit 24 - Power of Attorney |
| /s/ David Shapiro, by power of attorney | 04/17/2024 | |
| ** 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 5 (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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.