Form 4 VPC Impact Acquisition For: Jan 05 Filed by: Levy Richard N
January 6, 2022 7:22 PM EST
| 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
|
| OMB APPROVAL |
| OMB Number: |
3235-0287 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
|
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
*
| C/O VICTORY PARK CAPITAL ADVISORS, LLC |
| 150 NORTH RIVERSIDE PLAZA, SUITE 5200 |
(Street)
|
2. Issuer Name
and
Ticker or Trading Symbol
VPC Impact Acquisition Holdings III, Inc.
[
DAVE
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
X |
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
| See Remarks |
|
3. Date of Earliest Transaction
(Month/Day/Year)
01/05/2022
|
4. If Amendment, Date of Original Filed
(Month/Day/Year)
|
6. Individual or Joint/Group Filing (Check
Applicable Line)
|
Form filed by One Reporting Person |
| X |
Form filed by More than One Reporting
Person |
|
| Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned |
|---|
| 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 |
|
Class A common stock, par value $0.0001 per share
|
01/05/2022 |
|
M |
|
5,341,528
|
A
|
|
5,341,528
|
D
|
|
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 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 |
|
Class B common stock, par value $0.0001
|
|
01/05/2022 |
|
D |
|
|
942,622
|
|
|
Class A common stock
|
942,622
|
$
0
|
5,341,528
|
D
|
|
|
Class B common stock, par value $0.0001
|
|
01/05/2022 |
|
M |
|
|
5,341,528
|
|
|
Class A common stock
|
5,341,528
|
$
0
|
0
|
D
|
|
|
Private Placement Warrants
|
$
11.5
|
01/05/2022 |
|
A |
|
5,100,214
|
|
03/04/2022
|
01/05/2027
|
Class A common stock
|
5,100,214
|
$
1.5
|
5,100,214
|
D
|
|
| Explanation of Responses: |
|
|
|
| Remarks: |
Director by Deputization
Prior to the Closing VPC Impact Acquisition Holdings Sponsor III, LLC was a Director by Deputization See Exhibit 99.1 - Joint Filer Information, which is incorporated herein by reference and describes in further detail the relationships of the Reporting Persons to the Issuer. As a result of and immediately following the Closing, the Reporting Persons are no longer Directors by Deputization or 10% Owners, and therefore are no longer subject to Section 16 of the Securities Exchange Act of 1934. |
|
/s/ Brian Munsie, Attorney-in-Fact for VPC Impact Acquisition Holdings Sponsor III, LLC |
01/06/2022 |
|
** Signature of Reporting Person |
Date |
|
/s/ Brian Munsie, Attorney-in-Fact for Richard N. Levy |
01/06/2022 |
|
** 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
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. |
Exhibit 99.1
Joint Filer Information
Name of Joint Filer: VPC Impact Acquisition Holdings Sponsor
III, LLC
Address of Joint Filer: c/o Victory Park Capital Advisors, LLC
150 North Riverside Plaza, Suite 5200
Chicago, Illinois 60606
Relationship of Joint Filer to Issuer: 10% Owner, Director
Issuer Name and Ticker
or Trading Symbol: Dave Inc. [DAVE]
Date of Event Requiring Statement:
(Month/Day/Year): 1/5/2022
Name of Joint Filer: Richard N. Levy
Address of Joint Filer: c/o Victory Park Capital Advisors, LLC
150 North Riverside Plaza, Suite 5200
Chicago, Illinois 60606
Relationship of Joint Filer to Issuer: 10% Owner
Issuer Name and Ticker
or Trading Symbol: Dave Inc. [DAVE]
Date of Event Requiring Statement:
(Month/Day/Year): 1/5/2022
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