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*
Sanaby Health Sponsor I LLC

(Last) (First) (Middle)
C/O SANABY HEALTH ACQUISITION CORP. I
2625 MIDDLEFIELD ROAD #990

(Street)
PALO ALTO CA 94306

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/14/2021
3. Issuer Name and Ticker or Trading Symbol
Sanaby Health Acquisition Corp. I [ SANBU ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
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, par value $0.0001 per share (1) (1) Class A common stock, par value $0.0001 per share 5,175,000(2) (1) D(2)
Explanation of Responses:
1. As described in the Issuer's registration statement on Form S-1 (No. 333-259728), the shares of Class B common stock will automatically convert into shares of Class A common stock at the time of the Issuer's initial business combination on a one-for-one basis subject to certain adjustments and have no expiration date.
2. These shares represent the shares of Class B common stock held directly by Sanaby Health Sponsor I LLC (the "Sponsor"), acquired pursuant to a subscription agreement by and between the Sponsor and the Issuer. The shares of Class B common stock owned by the Sponsor include up to 675,000 shares that are subject to forfeiture in the event the underwriters of the initial public offering of the Issuer's securities do not exercise their over-allotment option in full as described in the Issuer's registration statement.
/s/ Sandra Shpilberg Name: Sandra Shpilberg Title: Managing Member 10/15/2021
** 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).
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