SEC Form 3
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*
Bohde Joshua

(Last) (First) (Middle)
251 N 1ST AVE
SUITE 200

(Street)
MINNEAPOLIS MN 55401

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/04/2022
3. Issuer Name and Ticker or Trading Symbol
Sezzle Inc. [ SZL.AX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Technology Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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 4,781 D
COMMON STOCK 128,641(1) D
COMMON STOCK 349,113(2) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Stock Options (right to buy) (3) 01/08/2029 COMMON STOCK 100,000 $0.05 D
Stock Options (right to buy) (4) 04/07/2030 COMMON STOCK 50,000 (5) D
Stock Options (right to buy) (6) 04/07/2030 COMMON STOCK 50,000 (5) D
Explanation of Responses:
1. Reflecting an award of restricted stock units vesting 100% on May 1, 2023.
2. Reflecting an award of restricted stock units vesting 100% on May 29, 2023.
3. The options vest and become exercisable over 4 years, beginning with 25% on the first anniversary of the vesting commencement date and then in equal monthly installments thereafter. The vesting commencement date is 1/8/2019 and 91,667 options were vested as of the reporting date.
4. The options vest and become exercisable over 4 years, beginning with 25% on the first anniversary of the vesting commencement date and then in equal monthly installments thereafter. The vesting commencement date is 7/26/2019 and 37,500 options were vested as of the reporting date.
5. The exercise price of AUD$1.35 per share is reported in Column 4 in US Dollars using a foreign exchange rate of 0.619515 on the grant date.
6. The options vest and become exercisable over 4 years, beginning with 25% on the first anniversary of the vesting commencement date and then in equal monthly installments thereafter. The vesting commencement date is 4/7/2020 and 28,125 options were vested as of the reporting date.
Remarks:
Exhibit 24.1 Power of Attorney filed herewith.
Timothy M. Joyce, Attorney-in-Fact 08/10/2022
** 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 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.
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