Initial Statement of Beneficial Ownership (3)
March 15 2021 - 6:15PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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0.5
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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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1. Name and Address of Reporting Person
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Bhattacharyya Ambar |
2. Date of Event Requiring Statement (MM/DD/YYYY)
3/5/2021
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3. Issuer Name and Ticker or Trading Symbol
Hims & Hers Health, Inc. [HIMS]
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(Last)
(First)
(Middle)
2269 CHESTNUT STREET, #523 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
SAN FRANCISCO, CA 94123
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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) |
Class A Common Stock | 610490 | I | Held by Maverick Advisors Fund, L.P. (1) |
Class A Common Stock | 1098602 | I | Held by Maverick Ventures Investment Fund, L.P. (2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Warrant (right to buy) | 1/20/2021 | 1/20/2026 | Class A Common Stock | 3412 | $11.50 | I | Held by Maverick Advisors Fund, L.P. (1) |
Warrant (right to buy) | 1/20/2021 | 1/20/2026 | Class A Common Stock | 6140 | $11.50 | I | Held by Maverick Ventures Investment Fund, L.P. (2) |
Explanation of Responses: |
(1) | The Reporting Person is a Member of Maverick Capital Ventures, LLC ("Maverick Ventures"), the general partner of Maverick Advisors Fund, L.P. The Reporting Person disclaims beneficial ownership of the securities held by Maverick Advisors Fund, L.P. and this report shall not be deemed an admission that he is the beneficial owner of such securities, except to the extent of his indirect pecuniary interest therein, if any, by virtue of his interest in Maverick Ventures. |
(2) | The Reporting Person is a Member of Maverick Ventures, the general partner of Maverick Ventures Investment Fund, L.P. The Reporting Person disclaims beneficial ownership of the securities held by Maverick Ventures Investment Fund, L.P. and this report shall not be deemed an admission that he is the beneficial owner of such securities, except to the extent of his indirect pecuniary interest therein, if any, by virtue of his interest in Maverick Ventures. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Bhattacharyya Ambar 2269 CHESTNUT STREET, #523 SAN FRANCISCO, CA 94123 | X |
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Signatures
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/s/ Soleil Boughton - Attorney-in-Fact | | 3/15/2021 |
**Signature of Reporting Person | Date |
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