SEC FORM
3
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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O SPORTSMAN'S WAREHOUSE |
| 7035 SOUTH HIGH TECH DRIVE |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
02/03/2019
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3. Issuer Name and Ticker or Trading Symbol
SPORTSMAN'S WAREHOUSE HOLDINGS, INC.
[ SPWH ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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|
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
|
| No securities are beneficially owned. |
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Kevan P. Talbot, as attorney in fact |
02/05/2019 |
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** 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. |
POWER OF ATTORNEY
FOR SEC FILINGS ON FORMS ID, 3, 4, 5 AND 144
IN RESPECT OF SECURITIES OF
SPORTSMAN'S WAREHOUSE HOLDINGS, INC.
The undersigned hereby constitutes and appoints each of Jon Barker and
Kevan Talbot of Sportsman's Warehouse Holdings, Inc. (the "Company") as his true
and lawful attorney-in-fact and agent, with full power of substitution and
resubstitution for him in his name and stead in any and all capacities, to sign
and file for and on his behalf, in respect of any acquisition, disposition or
other change in ownership of any common stock of the Company, the following:
(i) any Form ID to be filed with the Securities and Exchange Commission
(the "SEC");
(ii) any Initial Statement of Beneficial Ownership of Securities on Form
3 to be filed with the SEC;
(iii) any Statement of Changes of Beneficial Ownership of Securities on
Form 4 to be filed with the SEC;
(iv) any Annual Statement of Beneficial Ownership of Securities on Form 5
to be filed with the SEC;
(v) any Notice of Proposed Sale of Securities on Form 144 to be filed
with the SEC; and
(vi) any and all agreements, certificates, receipts, or other documents
in connection therewith.
The undersigned hereby gives full power and authority to the
attorney-in-fact to seek and obtain as the undersigned's representative and on
the undersigned's behalf, information on transactions in the Company's
securities from any third party, including brokers, employee benefit plan
administrators and trustees, and the undersigned hereby authorizes any such
person to release such information to the undersigned and approves and ratifies
any such release of information.
The undersigned hereby grants unto such attorney-in-fact and agent full
power and authority to do and perform each and every act and thing requisite and
necessary in connection with such matters and hereby ratifies and confirms all
that any such attorney-in-fact and agent or substitute may do or cause to be
done by virtue hereof.
The undersigned acknowledges that:
(i) neither the Company nor such attorney-in-fact assumes (i) any
liability for the undersigned's responsibility to comply with the
requirement of the Securities Exchange Act of 1934, as amended (the
"Exchange Act"), (ii) any liability of the undersigned for any
failure to comply with such requirements or (iii) any obligation or
liability of the undersigned for profit disgorgement under Section
16(b) of the Exchange Act; and
(ii) this Power of Attorney does not relieve the undersigned from
responsibility for compliance with the undersigned's obligations
under the Exchange Act, including without limitation the reporting
requirements under Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect until revoked
by the undersigned in a signed writing delivered to such attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney.
Date: February 5, 2019
/s/ Martha Bejar
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Martha Bejar
