0000950170-23-050189.txt : 20230927 0000950170-23-050189.hdr.sgml : 20230927 20230927172006 ACCESSION NUMBER: 0000950170-23-050189 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20230922 FILED AS OF DATE: 20230927 DATE AS OF CHANGE: 20230927 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Cipollone Paula CENTRAL INDEX KEY: 0001993631 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40478 FILM NUMBER: 231285499 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 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4800 N. SCOTTSDALE ROAD STREET 2: SUITE 6000 CITY: SCOTTSDALE STATE: AZ ZIP: 85251 BUSINESS PHONE: 602-767-2100 MAIL ADDRESS: STREET 1: 4800 N. SCOTTSDALE ROAD STREET 2: SUITE 6000 CITY: SCOTTSDALE STATE: AZ ZIP: 85251 3 1 ownership.xml 3 X0206 3 2023-09-22 0 0001845257 LifeStance Health Group, Inc. LFST 0001993631 Cipollone Paula C/O LIFESTANCE HEALTH GROUP, INC. 4800 N. SCOTTSDALE ROAD, SUITE 6000 SCOTTSDALE AZ 85251 false true false false See Remarks Common Stock 213093 D Includes 160,430 unvested restricted stock units ("RSUs"). Each RSU represents a contingent right to receive one share of the Issuer's common stock. Exhibit List: Exhibit 24 - Power of Attorney Business Transformation Officer /s/ Ryan Pardo, Attorney-in-Fact 2023-09-27 EX-24 2 lfst-ex24.htm EX-24 EX-24

 

LIMITED POWER OF ATTORNEY

 

The undersigned hereby constitutes and appoints Ken Burdick, Ryan Pardo and Dayna Atkins, and each of them individually, with full power of substitution, as the undersigned’s true and lawful attorney-in-fact to:

 

(1) prepare, execute in the undersigned’s name and on the undersigned’s behalf, and submit to the U.S. Securities and Exchange Commission (the “SEC”) a Form ID, including amendments thereto, and any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the SEC of reports required by Section 16(a) of the Securities Exchange Act of 1934, as amended, or any rule or regulation of the SEC;

 

(2) execute for and on behalf of the undersigned, in the undersigned’s capacity as officer and/or director of LifeStance Health Group, Inc. (the “Company”), Forms 3, 4, 5 and any Schedules 13D or 13G in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended, and the rules thereunder;

 

(3) do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to complete and execute any such Form 3, 4, or 5 or Schedule 13D or 13G, complete and execute any amendment or amendments thereto, and timely file such form with the SEC and any stock exchange or similar authority; and

 

(4) take any other action of any type whatsoever in connection with the foregoing that, in the opinion of each such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by each such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as each such attorney-in-fact may approve in each such attorney-in-fact’s discretion.

 

The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that each such attorney-in-fact, or each such attorney-in-fact’s substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that each foregoing attorney-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned’s responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended.

 

This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, 5, and any Schedules 13D or 13G with respect to the undersigned’s holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to each foregoing attorney-in-fact.


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IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 14th day of September 2023.

 

 

/s/ Paula Cipollone ________________

Name: Paula Cipollone

Signature Page to Limited Power of Attorney