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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
KAUFMAN IVAN

(Last) (First) (Middle)
333 EARLE OVINGTON BLVD. SUITE 900

(Street)
UNIONDALE NY 11553

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/28/2021
3. Issuer Name and Ticker or Trading Symbol
Arbor Rapha Capital Bioholdings Corp. I [ ARCK ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
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 4,312,500 (1) I By Arbor Rapha Capital LLC(2)
1. Name and Address of Reporting Person*
KAUFMAN IVAN

(Last) (First) (Middle)
333 EARLE OVINGTON BLVD. SUITE 900

(Street)
UNIONDALE NY 11553

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
1. Name and Address of Reporting Person*
Arbor Rapha Capital LLC

(Last) (First) (Middle)
333 EARLE OVINGTON BLVD. SUITE 900

(Street)
UNIONDALE NY 11553

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
1. Name and Address of Reporting Person*
ARBOR COMMERCIAL MORTGAGE LLC

(Last) (First) (Middle)
333 EARLE OVINGTON BLVD. SUITE 900

(Street)
UNIONDALE NY 11553

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
Explanation of Responses:
1. As described in the issuer's registration statement on Form S-1 (File No. 333-259516) under the heading "Description of Securities--Founder Shares," the Class B common stock of the issuer, par value $0.0001 per share, will automatically convert into Class A common stock of the issuer, par value $0.0001 per share, at the time of the issuer's initial business combination, or earlier at the option of the holder, on a one-for-one basis, subject to certain adjustments, and have no expiration date.
2. Arbor Rapha Capital LLC ("Sponsor") is the record holder of the shares of Class B common stock reported herein, which include 562,500 shares of Class B common stock that are subject to forfeiture to the extent that the underwriter of the issuer's public offering does not exercise its over-allotment option in full. Arbor Commercial Mortgage LLC ("ACM") is the managing member of Sponsor. Ivan Kaufman is President and Chief Executive Officer of ACM. As a result of the foregoing, Mr. Kaufman and ACM may be deemed to beneficially own shares held by Sponsor. Each of Mr. Kaufman and ACM disclaims beneficial ownership of the shares held by Sponsor except to the extent of his or its pecuniary interest therein.
Remarks:
Mr. Kaufman serves on the board of directors of the issuer and serves as its Chief Executive Officer. On the basis of the relationship between Sponsor and Mr. Kaufman, Sponsor may be deemed a director by deputization with respect to the issuer for the purposes of Section 16 of the Securities Exchange Act of 1934, as amended.
/s/ Ivan Kaufman, as President and Chief Executive Officer of Arbor Commercial Mortgage LLC, Managing Member of Arbor Rapha Capital LLC 10/28/2021
/s/ Ivan Kaufman, as President and Chief Executive Officer of Arbor Commercial Mortgage LLC 10/28/2021
/s/ Ivan Kaufman 10/28/2021
** 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.