Statement of Changes in Beneficial Ownership (4)
08 Marzo 2021 - 11:19PM
Edgar (US Regulatory)
FORM 4
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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).
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
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JCIC Sponsor LLC |
2. Issuer Name and Ticker or Trading Symbol
Jack Creek Investment Corp.
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JCIC
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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)
C/O JACK CREEK INVESTMENT CORP.,, 386 PARK AVENUE SOUTH, FL 20 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/8/2021 |
(Street)
NEW YORK, NY 10016
(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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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 |
Class B Ordinary Shares, par value $0.0001 per share | (2) | 3/8/2021 | | S | | | 25000 (2) | (2) | (2) | Class A Ordinary Shares, par value $0.0001 per share | 25000 | $0.0029 (2) | 8550000 | I | See footnotes (1)(3)(4) |
Explanation of Responses: |
(1) | This form is being filed by the following Reporting Persons: JCIC Sponsor LLC (the "Sponsor"), KSH Capital LP ("KSH Capital"), Jeffrey E. Kelter, Robert F. Savage and Thomas Jermoluk. Because of the relationships among the Reporting Persons, the Reporting Persons may be deemed to beneficially own the securities reported herein to the extent of their respective pecuniary interests. Each Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of such Reporting Person's pecuniary interest therein, if any. |
(2) | Sponsor sold 25,000 shares of Class B ordinary shares, par value $0.0001 per share (the "Class B Ordinary Shares") for the aggregate consideration of $72.46. Class B Ordinary Shares have no expiration date and are convertible into Class A ordinary shares, par value $0.0001 per share, of the Issuer, as described under the heading "Description of Securities-founder shares" in the Issuer's registration statement on Form S-1 (File No. 333-248951). |
(3) | The manager of the Sponsor is KSH Capital. Each of Jeffrey E. Kelter, Robert F. Savage and Thomas Jermoluk indirectly own an approximately 30% interest in Sponsor and, pursuant to the Sponsor's operating agreement, through their investment vehicles have a consent right over the Sponsor's investments, including voting and investment discretion with respect to the Class B Ordinary Shares held of record by the Sponsor. |
(4) | Pursuant to Rule 16a-1(a)(4) under the Exchange Act, this filing shall not be deemed an admission that the Reporting Persons are, for purposes of Section 16 of the Exchange Act or otherwise, the beneficial owners of any equity securities in excess of their respective pecuniary interests. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
JCIC Sponsor LLC C/O JACK CREEK INVESTMENT CORP., 386 PARK AVENUE SOUTH, FL 20 NEW YORK, NY 10016 |
| X |
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KSH Capital LP C/O JACK CREEK INVESTMENT CORP., 386 PARK AVENUE SOUTH, FL 20 NEW YORK, NY 10016 |
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| Manager |
KELTER JEFFREY E C/O JACK CREEK INVESTMENT CORP., 386 PARK AVENUE SOUTH, FL 20 NEW YORK, NY 10016 | X |
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SAVAGE ROBERT F JR C/O JACK CREEK INVESTMENT CORP., 386 PARK AVENUE SOUTH, FL 20 NEW YORK, NY 10016 |
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| Chief Executive Officer |
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JERMOLUK THOMAS C/O JACK CREEK INVESTMENT CORP., 386 PARK AVENUE SOUTH, FL 20 NEW YORK, NY 10016 | X |
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Signatures
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/s/ Robert Savage, JCIC Sponsor LLC, By its Manager, KSH CAPITAL LP, Acting by its General Partner, KSH CAPITAL GP LLC, Robert Savage, President | | 3/8/2021 |
**Signature of Reporting Person | Date |
* KSH Capital LP | | 3/8/2021 |
**Signature of Reporting Person | Date |
* Jeffrey E. Kelter | | 3/8/2021 |
**Signature of Reporting Person | Date |
* Robert F. Savage | | 3/8/2021 |
**Signature of Reporting Person | Date |
* Thomas Jermoluk | | 3/8/2021 |
**Signature of Reporting Person | Date |
*By: /s/ Lauren Ores, Attorney-in-Fact | | 3/8/2021 |
**Signature of Reporting Person | Date |
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