Amended Statement of Beneficial Ownership (3/a)
September 06 2022 - 6:05PM
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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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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CARVANA CO. |
2. Date of Event Requiring Statement (MM/DD/YYYY)
9/1/2022
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3. Issuer Name and Ticker or Trading Symbol
Root, Inc. [ROOT]
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(Last)
(First)
(Middle)
1930 W RIO SALADO PARKWAY |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director ___X___ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
TEMPE, AZ 85281
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY) 10/8/2021
| 6. Individual or Joint/Group Filing(Check Applicable Line)
___ Form filed by One Reporting Person
_X_ 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) |
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) | 9/1/2022 (1)(2) | 9/1/2025 | Class A Common Stock | 2364527.0 | $180.1 | I | See Footnotes (3) |
Warrant (Right to Buy) | (1) | 9/1/2025 | Class A Common Stock | 3209001.0 | $198.11 | I | See Footnotes (3) |
Warrant (Right to Buy) | (1) | 9/1/2025 | Class A Common Stock | 1594149.0 | $216.12 | I | See Footnotes (3) |
Warrant (Right to Buy) | (1) | 9/1/2027 | Class A Common Stock | 1435023.0 | $180.1 | I | See Footnotes (3) |
Warrant (Right to Buy) | (1) | 9/1/2027 | Class A Common Stock | 1491046.0 | $225.13 | I | See Footnotes (3) |
Warrant (Right to Buy) | (1) | 9/1/2027 | Class A Common Stock | 1502593.0 | $270.15 | I | See Footnotes (3) |
Warrant (Right to Buy) | (1) | 9/1/2027 | Class A Common Stock | 1451763.0 | $405.23 | I | See Footnotes (3) |
Warrant (Right to Buy) | (1) | 9/1/2027 | Class A Common Stock | 1287177.0 | $540.31 | I | See Footnotes (3) |
Series A Convertible Preferred Stock | (4) | (4) | Class A Common Stock | 780294.0 (5) | $162.09 | I | See Footnotes (6) |
Explanation of Responses: |
(1) | This amendment is being filed to reflect warrants to purchase Class A Common Stock (the "Warrants" and individually a "Warrant") of Root, Inc. (the "Issuer"), which were acquired pursuant to the Investment Agreement, dated August 11, 2021, by and between the Issuer and Carvana Group, LLC, which were omitted from the original Form 3 filed by the Reporting Persons. The Warrants are subject to certain conditions to exercise, including conditions relating to the achievement of defined milestones tied to the business integration. |
(2) | The Warrant became exercisable on September 1, 2022, upon completion of the integrated automobile insurance solution for Carvana Group, LLC's online car buying platform. |
(3) | The Warrants are held directly by Carvana Group, LLC. Carvana Co. exercises voting and dispositive power over the Warrants. |
(4) | The Series A Convertible Preferred Stock (the "Preferred Stock") is convertible at any time, at the holder's election, and has no expiration date. The Preferred Stock converts into a number of fully paid and non-assessable shares of Class A Common Stock of the Issuer, determined in accordance with the then-effective Conversion Rate. The "Conversion Rate" is equal to the initial liquidation preference of $9.00 divided by the Conversion Price. The Conversion Price is subject to customary adjustments, including in the event of any stock split, reverse stock split, stock dividend, recapitalization or similar events. |
(5) | 780,294 shares of Class A Common Stock of the Issuer are issuable upon conversion of 14,053,096 shares of Preferred Stock of the Issuer. The number of shares reported in this Form 3 account for the one-for-eighteen reverse stock split effected by the Issuer on August 12, 2022. |
(6) | Represents Preferred Stock held directly by Carvana Group, LLC. Carvana Co. exercises voting and dispositive power over the Preferred Stock. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
CARVANA CO. 1930 W RIO SALADO PARKWAY TEMPE, AZ 85281 |
| X |
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CARVANA GROUP, LLC 1930 W RIO SALADO PARKWAY TEMPE, AZ 85281 |
| X |
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Signatures
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Carvana Co., By: /s/ Paul Breaux, Vice President, General Counsel and Secretary | | 9/6/2022 |
**Signature of Reporting Person | Date |
Carvana Group, LLC, By: Carvana Co. Sub LLC, its Sole Manager, By: Carvana Co., its Sole Manager, By /s/ Paul Breaux, Vice President, General Counsel and Secretary. | | 9/6/2022 |
**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 control number. |
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