FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/13/2012 |
3. Issuer Name and Ticker or Trading Symbol
JTH Holding, Inc. [ LTAXA ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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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) |
Class A Common Stock | 3,380,000 | D | |
Special Voting Preferred Stock(1) | 10 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: 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 | ||||
Class A Convertible Preferred Stock | (2) | (2) | Class A Common Stock | 300,000 | (2) | D | |
Exchangeable Shares | (3) | (3) | Class A Common Stock | 1,000,000 | (3) | D |
Explanation of Responses: |
1. The holders of Special voting Preferred Stock are entitled to vote as one class with the holders of Class A Common Stock based upon each share of Special Voting Preferred Stock being entitled to vote as if it represented 100,000 shares of Class A Common Stock. |
2. The holder of any shares of Class A Convertible Preferred Stock has the right, at such holder's option, at any time and from time to time to convert any of such shares of Class A Convertible Preferred Stock into shares of Class A Common Stock at the rate of ten shares of Class A Common Stock for each share of Class A Convertible Preferred Stock. Each share of Class A Convertible Preferred Stock may automatically convert into shares of Class A Common Stock in certain circumstances, as set forth in the Issuer's Amended and Restated Certificate of Incorporation. |
3. Consists of 100,000 Exchangeable Shares of Liberty Tax Holding Corporation, a wholly-owned subsidiary of Issuer, which may be exchanged for shares of Class A Common Stock of Issuer at any time and from time to time, subject to retraction or redemption by Issuer in certain circumstances, on a ten-for-one basis, subject to adjustment, and have no expiration date. In order to exchange any Exchangeable Share for Class A Common Stock, the holder thereof is required to deliver to Issuer for cancellation the number of shares of Special Voting Preferred Stock of Issuer corresponding to the number of Exchangeable Shares being exchanged (with the exchange of 10,000 Exchangeable Shares requiring delivery for cancellation of 1 share of Special Voting Preferred Stock, subject to adjustment). |
Steven Ibbotson, Director | 06/13/2012 | |
** 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 5 (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. |