0001567619-21-013803.txt : 20210721 0001567619-21-013803.hdr.sgml : 20210721 20210721164032 ACCESSION NUMBER: 0001567619-21-013803 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210720 FILED AS OF DATE: 20210721 DATE AS OF CHANGE: 20210721 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Casey Ted CENTRAL INDEX KEY: 0001856959 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38785 FILM NUMBER: 211104916 MAIL ADDRESS: STREET 1: 5801 TENNYSON PKWY SUITE 275 CITY: PLANO STATE: TX ZIP: 75024 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: STRYVE FOODS, INC. CENTRAL INDEX KEY: 0001691936 STANDARD INDUSTRIAL CLASSIFICATION: FOOD & KINDRED PRODUCTS [2000] IRS NUMBER: 000000000 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 5801 TENNYSON PARKWAY STREET 2: SUITE 275 CITY: PLANO STATE: TX ZIP: 75024 BUSINESS PHONE: 646-565-3861 MAIL ADDRESS: STREET 1: 5801 TENNYSON PARKWAY STREET 2: SUITE 275 CITY: PLANO STATE: TX ZIP: 75024 FORMER COMPANY: FORMER CONFORMED NAME: Andina Acquisition Corp. III DATE OF NAME CHANGE: 20161208 4 1 doc1.xml FORM 4 X0306 4 2021-07-20 0 0001691936 STRYVE FOODS, INC. ANDA 0001856959 Casey Ted C/O STRYVE FOODS, INC. 5801 TENNYSON PARKWAY, SUITE 275 PLANO TX 75024 1 0 0 0 Class V Common Stock 2021-07-20 4 A 0 1478524 A 1478524 I See Footnote Class A Common Stock 2021-07-20 4 C 0 101301 A 101301 D Class A Common Stock 2021-07-20 4 C 0 128306 A 128306 I See Footnote Class B Units 2021-07-20 4 A 0 1478524 A Class A Common Stock 1478524 1478524 I See Footnote Convertible Bridge Note 2021-07-20 4 C 0 101301 D Class A Common Stock 101301 0 D Convertible Bridge Note 2021-07-20 4 C 0 128306 D Class A Common Stock 128306 0 I See Footnote Subject to the terms of an Exchange Agreement with Stryve Foods, Inc. ("Stryve"), a set of one Class B Unit and one share of Class V Common Stock is exchangeable for one share of Class A Common Stock of Stryve after the expiration of a lock-up applicable to such securities. The Class V Common Stock provides the holder with voting rights, but not economic rights, with respect to Stryve. Securities issued to Stryve Foods Holdings, LLC in connection with a business combination with the Issuer. All shares of Class V Common Stock and Class B Units are beneficially owned as a member of Stryve Foods Holdings, LLC. All principal and interest due under promissory notes (the "Bridge Notes") of Stryve Foods, LLC ( "Stryve") was satisfied through the issuance of shares of Class A Common Stock in connection with the business combination between Stryve Foods, Inc. (formerly known as Andina Acquisition Corp. III) and Stryve. One-half of the securities are owned by the TRC GST TRFBO Trinity Jennifer Wommack Casey BTD 09302011 and the other half are owned by TRC GST TRFBO Avery Maryanna Wommack Casey BTD 09302011. Thomas Farrell Casey is the trustee and control person of, with voting and dispositive power over the securities held by, such trusts. The reporting person disclaims beneficial ownership of the securities owned by the trusts. /s/ Ted Casey by John J. Wolfel, Attorney-in-Fact 2021-07-21