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*
Health Connect Acquisitions Holdings LLC

(Last) (First) (Middle)
C/O SENIOR CONNECT ACQUISITION CORP. I
7114 EAST STETSON DRIVE, SUITE 400

(Street)
SCOTTSDALE AZ 85251

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/10/2020
3. Issuer Name and Ticker or Trading Symbol
Senior Connect Acquisition Corp. I [ SNRH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) X Other (specify below)
*Director by Deputization
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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)
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
Class B Common Stock (1) (1) Class A Common Stock 10,350,000 (1) D(2)
1. Name and Address of Reporting Person*
Health Connect Acquisitions Holdings LLC

(Last) (First) (Middle)
C/O SENIOR CONNECT ACQUISITION CORP. I
7114 EAST STETSON DRIVE, SUITE 400

(Street)
SCOTTSDALE AZ 85251

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director X 10% Owner
Officer (give title below) X Other (specify below)
*Director by Deputization
1. Name and Address of Reporting Person*
BURKE RICHARD T

(Last) (First) (Middle)
C/O SENIOR CONNECT ACQUISITION CORP. I
7114 EAST STETSON DRIVE, SUITE 400

(Street)
SCOTTSDALE AZ 85251

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
X Officer (give title below) Other (specify below)
Chairman, CFO
1. Name and Address of Reporting Person*
Applbaum Isaac

(Last) (First) (Middle)
C/O SENIOR CONNECT ACQUISITION CORP. I
7114 EAST STETSON DRIVE, SUITE 400

(Street)
SCOTTSDALE AZ 85251

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
X Officer (give title below) Other (specify below)
President
1. Name and Address of Reporting Person*
Burke Ryan Matthew

(Last) (First) (Middle)
C/O SENIOR CONNECT ACQUISITION CORP. I
7114 EAST STETSON DRIVE, SUITE 400

(Street)
SCOTTSDALE AZ 85251

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Financial Officer
Explanation of Responses:
1. The shares of Class B Common Stock are convertible for shares of the Issuer's Class A Common Stock as described under the heading "Description of Securities" in the Issuer's Registration Statement on Form S-1 (File No. 333-250932) (the "Registration Statement") and have no expiration date. The shares of Class B Common Stock beneficially owned by the Reporting Person includes up to 1,350,000 shares of Class B Common Stock subject to forfeiture to the Issuer depending on the extent to which the underwriters' over-allotment option is exercised in connection with the Issuer's initial public offering of units, as described in the Registration Statement.
2. Health Connect Acquisitions Holdings LLC (the "Sponsor") is the record holder of the shares reported herein. Each of Isaac Applbaum, Richard Burke and Ryan Burke are the managers of the Sponsor. Any action by the Sponsor with respect to the Issuer or the shares reported herein, including voting and dispositive decisions, requires a majority vote of the managers. No individual manager exercises voting or dispositive control over any of the securities held by the Sponsor, even those in which he directly owns a pecuniary interest. Accordingly, none of Messrs. Applbaum, Burke or Burke will be deemed to have or share beneficial ownership of such securities.
Remarks:
See Exhibit 99.1 - Joint Filer Information, which is incorporated herein by reference and describes in further detail the relationships of the Reporting Person to the Issuer. See Exhibits 24.1, 24.2, 24.3 and 24.4 - Powers of Attorney.
/s/ Adam Berkaw, Attorney-in-Fact for Health Connect Acquisitions Holdings LLC 12/10/2020
/s/ Adam Berkaw, Attorney-in-Fact for Richard Burke 12/10/2020
/s/ Adam Berkaw, Attorney-in-Fact for Isaac Applbaum 12/10/2020
/s/ Adam Berkaw, Attorney-in-Fact for Ryan Matthew Burke 12/10/2020
** 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).
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