SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Life Time Group Holdings, Inc. [ LTH ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 10/12/2021 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) 10/14/2021 | 6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 10/12/2021 | C | 150,787 | A | (1) | 3,150,787 | D(2)(3) | |||
Common Stock | 10/12/2021 | P | 227,777 | A | $18 | 3,378,564 | D(2)(3) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) | 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: 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 | ||||||||
Series A Preferred Stock | (1) | 10/12/2021 | C | 122,429 | (1) | (1) | Common Stock | 150,787 | (1) | 0 | D(2)(3) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. Each share of Series A preferred stock automatically converted into common stock upon the closing of the Issuer's initial public offering in accordance with the Certificate of Designations pertaining to the Series A preferred stock. |
2. Each of Colwood Investment Holding Inc. (as sole director of the Reporting Person), JSS Private Investments Fund I (as stockholder of the Reporting Person), JSS Private Equity Investments Fund GP S.a.r.l. (as general partner of JSS Private Investments Fund I), J. Safra Sarasin Fund Management (Luxembourg) S.A. and J. Safra Sarasin Asset Management (Europe) Limited (as investment manager and sub-manager, respectively, of JSS Private Investments Fund I), J. Safra Sarasin Holding AG (as stockholder of JSS Private Equity Investments Fund GP S.a.r.l.), J. Safra Holdings International (Luxembourg) S.A. (as stockholder of J. Safra Sarasin Holding AG), |
3. J. Safra Holdings Luxembourg S.a.r.l. (as stockholder of J. Safra Holdings International (Luxembourg) S.A.) and JS International Holdings Limited (as stockholder of J. Safra Holdings Luxembourg S.a.r.l.) (collectively, "Other Reporting Persons") may be deemed to share beneficial ownership of the shares of common stock and Series A preferred stock held by the Reporting Person within the meaning of Section 13 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"). |
Remarks: |
Each of the the Reporting Person and Other Reporting Persons, and each of their respective directors, officers, partners, stockholders, members and managers, expressly disclaims beneficial ownership of these securities, except to the extent of any pecuniary interest therein, and this Form 4 should not be deemed an admission that any such person is the beneficial owner of, or has any pecuniary interest in, such securities for purposes of Section 16 of the Exchange Act or for any other purpose. This filing amends the original solely to add signature blocks for the Other Reporting Persons. |
JSS LTF HOLDINGS LTD By: /s/ Daniel Wainberg Daniel Wainberg Authorized Person By: /s/ Jose Bouzas Jose Bouzas Authorized Person | 12/17/2021 | |
Colwood Investment Holding Inc. By: /s/ Jose Bouzas Jose Bouzas Director /s/ Israel Borba Israel Borba Director | 12/17/2021 | |
JSS Private Investments Fund I By: JSS Private Equity Investments Fund GP S.a.r.l, as its managing general partner By: /s/ Ronnie Neefs Ronnie Neefs Director /s/ Robert Hamidou Robert Hamidou Authorized Signatory | 12/17/2021 | |
JSS Private Equity Investments Fund GP S.a.r.l By: /s/ Ronnie Neefs Ronnie Neefs Director /s/ Robert Hamidou Robert Hamidou Authorized Signatory | 12/17/2021 | |
J. Safra Sarasin Fund Management (Luxembourg) S.A. By: /s/Ronnie Neefs Ronnie Neefs Conducting Officer /s/Robert Hamidou Robert Hamidou Authorized Signatory | 12/17/2021 | |
J. Safra Sarasin Asset Management (Europe) Limited By: /s/ Abigail Carroll Abigail Carroll Director /s/ Adam Chaplin Adam Chaplin Chief Operating Officer | 12/17/2021 | |
J. Safra Sarasin Holding AG By: /s/ Stephane Astruc Stephane Astruc Authorized Signatory /s/ Salomon Sebban Salomon Sebban Authorized Signatory | 12/17/2021 | |
J. Safra Holdings International (Luxembourg) S.A. By: /s/ Gonzalo Pintos Gonzalo Pintos Director /s/ Pascoal Bruno Pascoal Bruno Director | 12/17/2021 | |
J. Safra Holdings Luxembourg S.a.r.l. By: /s/ Gonzalo Pintos Gonzalo Pintos Manager /s/ Pascoal Bruno Pascoal Bruno Manager | 12/17/2021 | |
JS International Holdings Limited By: /s/ Jose Bouzas Jose Bouzas Director /s/ Israel Borba Israel Borba Director | 12/17/2021 | |
** 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 4 (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. |