Clark Jermoluk Founders Fund I LLC - 17 Apr 2024 Form 3 Insider Report for Ibotta, Inc. (IBTA)

Role
10%+ Owner
Signature
/s/ James H. Clark
Issuer symbol
IBTA
Transactions as of
17 Apr 2024
Net transactions value
$0
Form type
3
Filing time
17 Apr 2024, 20:32:38 UTC
Next filing
22 Apr 2024
SEC
View on sec.gov

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
holding IBTA Series B Preferred Stock 17 Apr 2024 Common Stock 3,520,804 Direct F1, F2, F3
holding IBTA Series C Preferred Stock 17 Apr 2024 Common Stock 1,862,545 Direct F2, F3, F4
holding IBTA Series C-1 Preferred Stock 17 Apr 2024 Common Stock 379,108 Direct F2, F3, F5
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Each share of Series B Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock (the "IPO") and has no expiration date.
F2 Each share of Common Stock shall be reclassified into one share of Class A Common Stock immediately prior to the completion of the IPO.
F3 The shares are held by Clark Jermoluk Founders Fund I LLC, which is 95% owned by the JHC Family 2016 Trust (the "JHC Trust"). The JHC Trust is an entity controlled by James H. Clark.
F4 Each share of Series C Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the IPO and has no expiration date.
F5 Each share of Series C-1 Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the IPO and has no expiration date.