Initial Statement of Beneficial Ownership (3)
April 29 2021 - 6:25PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
JOHN ROSATTI REVOCABLE TRUST |
2. Date of Event Requiring Statement (MM/DD/YYYY)
12/16/2020
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3. Issuer Name and Ticker or Trading Symbol
BurgerFi International, Inc. [BFIIW]
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(Last)
(First)
(Middle)
U/A DTD 08/27/2001- CUSTODY, 101 US HIGHWAY 1 |
4. 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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(Street)
NORTH PALM BEACH, FL 33408
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 5004340 | I | See Footnote (1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | The John Rosatti Family Trust dated August 27, 2001, as amended, received 5,004,340 shares (the "Shares") of Common Stock in connection business combination (the "Business Combination") with BurgerFi International, LLC, a Delaware limited liability company ("BurgerFi LLC"), the members of BurgerFi LLC ("Members"), and BurgerFi Holdings, LLC, a Delaware limited liability company ("BurgerFi Holdings"), pursuant to that certain membership interest purchase agreement of June 29, 2020, as amended on September 22, 2020 (the "Acquisition Agreement") among OPES, BurgerFi, LLC the Members and BurgerFi Holdings. The address of The John Rosatti Family Trust dated August 27, 2001, as amended is 101 US Highway 1, North Palm Beach, Florida 33408. John Rosatti, as trustee, has voting and dispositive power over the Shares. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
JOHN ROSATTI REVOCABLE TRUST U/A DTD 08/27/2001- CUSTODY 101 US HIGHWAY 1 NORTH PALM BEACH, FL 33408 |
| X |
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Signatures
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/s/ John Rosatti, Trustee | | 4/28/2021 |
**Signature of Reporting Person | Date |
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