0000899243-21-023413.txt : 20210611
0000899243-21-023413.hdr.sgml : 20210611
20210611205854
ACCESSION NUMBER: 0000899243-21-023413
CONFORMED SUBMISSION TYPE: 3/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210610
FILED AS OF DATE: 20210611
DATE AS OF CHANGE: 20210611
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Qureshi Danish J.
CENTRAL INDEX KEY: 0001864331
FILING VALUES:
FORM TYPE: 3/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40478
FILM NUMBER: 211012989
MAIL ADDRESS:
STREET 1: 4800 N. SCOTTSDALE ROAD
STREET 2: SUITE 6000
CITY: SCOTTSDALE
STATE: AZ
ZIP: 85251
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: LifeStance Health Group, Inc.
CENTRAL INDEX KEY: 0001845257
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HEALTH SERVICES [8000]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
BUSINESS ADDRESS:
STREET 1: 4800 N. SCOTTSDALE ROAD
STREET 2: SUITE 6000
CITY: SCOTTSDALE
STATE: AZ
ZIP: 85251
BUSINESS PHONE: 425-279-8500
MAIL ADDRESS:
STREET 1: 4800 N. SCOTTSDALE ROAD
STREET 2: SUITE 6000
CITY: SCOTTSDALE
STATE: AZ
ZIP: 85251
3/A
1
doc3a.xml
FORM 3/A SUBMISSION
X0206
3/A
2021-06-10
2021-06-10
0
0001845257
LifeStance Health Group, Inc.
LFST
0001864331
Qureshi Danish J.
C/O LIFESTANCE HEALTH GROUP, INC.
4800 N. SCOTTSDALE ROAD, SUITE 6000
SCOTTSDALE
AZ
85251
0
1
0
0
Chief Growth Officer
Common Stock
4318279
D
Common Stock
589002
I
By Trust
Common Stock
589002
I
By Trust
Common Stock
589002
I
By Trust
Common Stock
589002
I
By Trust
Common Stock
589002
I
By Trust
Common Stock
589002
I
By Trust
Common Stock
589002
I
By Trust
Common Stock
589002
I
By Trust
Common Stock
589002
I
By Trust
Common Stock
589002
I
By Trust
Includes 3,264,998 shares of restricted stock and 550,988 restricted stock units ("RSUs"). Each RSU represents a contingent right to receive one share of the Issuer's common stock.
Shares held of record by the Qureshi Marital Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Securities Exchange Act of 1934 (the "Exchange Act") or for any other purpose.
Shares held of record by the Qureshi Mother's Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Exchange Act or for any other purpose.
Shares held of record by the Qureshi Irrevocable Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Exchange Act or for any other purpose.
Shares held of record by the Qureshi Legacy Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Exchange Act or for any other purpose.
Shares held of record by the Qureshi Children's Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Exchange Act or for any other purpose.
Shares held of record by the Khan Marital Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Exchange Act or for any other purpose.
Shares held of record by the Khan Descendants Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Exchange Act or for any other purpose.
Shares held of record by the Khan Irrevocable Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Exchange Act or for any other purpose.
Shares held of record by the Khan Legacy Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Exchange Act or for any other purpose.
Shares held of record by the Khan Parents Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities on this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the reported securities for purposes of Section 16 of the Exchange Act or for any other purpose.
This amendment is being filed solely to amend the original Form 3 filed by the Reporting Person to include RSUs granted in connection with the Issuer's initial public offering.
By: /s/ Ryan Pardo, Attorney-in-Fact
2021-06-11