Statement of Changes in Beneficial Ownership (4)
22 Septiembre 2021 - 10:36AM
Edgar (US Regulatory)
FORM 4
[X]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
*
Wayzata Investment Partners LLC |
2. Issuer Name and Ticker or Trading Symbol
Lazydays Holdings, Inc.
[
LAZY
]
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5. 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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(Last)
(First)
(Middle)
ONE CARLSON PARKWAY NORTH, SUITE 220 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/16/2021 |
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(Street)
PLYMOUTH, MN 55447
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
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X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common Stock | 9/16/2021 | | J(1) | | 1967841 | D | $0.00 | 93679 | I | See footnote (2) |
| Common Stock | 9/16/2021 | | J(1) | | 283438 | D | $0.00 | 14947 | I | See footnote (3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security
(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) |
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Explanation of Responses: |
| (1) | This transaction represents the distribution of shares by the reporting persons pursuant to a pro rata distribution, without consideration, of shares of the Issuer's common stock effected on September 16, 2021 to its general partners and limited partners. The distribution of the shares received in this distribution is exempt pursuant to Rule 16a-9. |
| (2) | Wayzata Opportunities Fund II, L.P |
| (3) | Wayzata Opportunities Fund Offshore II, L.P. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Wayzata Investment Partners LLC
ONE CARLSON PARKWAY NORTH, SUITE 220
PLYMOUTH, MN 55447 |
| X |
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Halloran Patrick J.
ONE CARLSON PARKWAY NORTH SUITE 220
PLYMOUTH, MN 55447 |
| X |
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WAYZATA OPPORTUNITIES FUND II, L.P.
ONE CARLSON PARKWAY NORTH SUITE 220
PLYMOUTH, MN 55447 |
| X |
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Wayzata Opportunities Fund Offshore II, L.P.
ONE CARLSON PARKWAY NORTH SUITE 220
PLYMOUTH, MN 55447 |
| X |
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Signatures
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| /s/ Patrick J. Halloran Wayzata Investment Partners LLC, by Patrick J. Halloran, Manager | | 9/22/2021 |
| **Signature of Reporting Person | Date |
| /s/ Patrick J. Halloran | | 9/22/2021 |
| **Signature of Reporting Person | Date |
| /s/ Patrick J. Halloran WAYZATA OPPORTUNITIES FUND II, L.P., by WOF II GP, L.P., its General Partner, by: WOF II GP, LLC, its General Partner, by: Patrick J. Halloran, Authorized Signatory | | 9/22/2021 |
| **Signature of Reporting Person | Date |
| /s/ Patrick J. Halloran WAYZATA OPPORTUNITIES FUND OFFSHORE II, L.P., by Wayzata Offshore GP II, LLC, its General Partner, Patrick J. Halloran, Authorized Signatory | | 9/22/2021 |
| **Signature of Reporting Person | Date |
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