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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
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 Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Class B Common Stock | (3) | (3) | (3) | Class A Common Stock | 10,450,000 | 10,450,000 (2) (4) | D (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
ShoulderUP Technology Sponsor, LLC C/O SHOULDERUP TECHNOLOGY ACQUISITION CORP. 125 TOWNPARK DRIVE, SUITE 300 KENNESAW, GA 30144 |
X |
By: /s/ Phyllis W. Newhouse, as the Managing Member of ShoulderUp Technology Sponsor LLC | 11/23/2021 | |
**Signature of Reporting Person | Date | |
/s/ Phyllis W. Newhouse | 11/23/2021 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Consists of 13,500,000 units of the issuer, purchased by ShoulderUp Technology Sponsor LLC (the "Sponsor") in a private placement transaction for $10.00 per unit. Each such unit consists of one share of Class A common stock and one-half of one redeemable warrant. |
(2) | The Sponsor is the record holder of the shares reported herein. Phyllis Newhouse is the managing member of the Sponsor and may be deemed to have or share the beneficial ownership of the securities held by the Sponsor. Ms. Newhouse is also a director of and the Chief Executive Officer of the issuer. Ms. Newhouse disclaims beneficial ownership over any securities except to the extent of her pecuniary interest therein. |
(3) | The shares of Class B common stock will automatically convert into shares of Class A common stock at the time of the issuer's initial business combination as described under the heading "Description of Securities - Founder Shares and Private Placement Shares" in the issuer's registration statement on Form S-1, as amended (File No. 333-260503), on a one-for-one basis, subject to adjustment for stock splits, stock capitalizations, reorganizations, recapitalizations and the like, and certain anti-dilution rights. The shares of Class B common stock have no expiration date. |
(4) | On November 19, 2021, the issuer effected a 1.0627119 for 1 stock split of the Class B common stock, which resulted in a change from 9,833,333 shares to 10,450,000 shares of Class B common stock as of such date. |