Annual Statement of Changes in Beneficial Ownership (5)
06 Februar 2023 - 10:38PM
Edgar (US Regulatory)
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FORM 5
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response... 1.0 |
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Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
| 1. Name
and Address of Reporting Person * RJC GIS Holdings
LLC |
2. Issuer Name and Ticker or Trading
SymbolHireRight Holdings Corp [HRT] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director __X__
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
|
|
(Last)
(First)
(Middle)
C/O HIRERIGHT HOLDINGS CORPORATION,, 100 CENTERVIEW DRIVE,
SUITE 300 |
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2022
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|
(Street)
NASHVILLE, TN 37214
(City)
(State)
(Zip)
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4. If Amendment, Date Original
Filed(MM/DD/YYYY)
|
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 Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership
(Instr. 4) |
|
Amount |
(A) or (D) |
Price |
|
Common Stock |
12/22/2022 |
|
G |
125000 |
D |
$0.00 |
10770969 (1) |
D (2) |
|
Table II - Derivative Securities Acquired, Disposed of, or
Beneficially Owned (e.g., puts, calls, warrants, options,
convertible securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date
(MM/DD/YYYY) |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of Derivative Securities Beneficially
Owned at End of Issuer's Fiscal Year
(Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I)
(Instr. 4) |
11. Nature of Indirect Beneficial Ownership
(Instr. 4) |
|
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of
Responses: |
| (1) |
All of the interests in RJC
GIS Holdings, LLC are held by (a) The Raymond W. Conrad Revocable
Trust dated April 17, 2009, of which Raymond Conrad is trustee; (b)
The Jeanne S. Conrad Revocable Trust dated April 17, 2009, of which
Jeanne Conrad is trustee; (c) The RWC Family Trust, of which Jeanne
Conrad is trustee; and (d) the JSC Family Trust, of which Raymond
Conrad is trustee. |
| (2) |
The reporting persons state
that neither the filing of this statement nor anything herein shall
be deemed an admission that such person is, for purposes of Section
16 of the Securities Exchange Act of 1934, as amended (the
"Exchange Act"), or otherwise, the beneficial owner of any
securities covered by this statement. The reporting persons
disclaim beneficial ownership of the securities covered by this
statement, except to the extent of the pecuniary interest of such
person in such securities. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
RJC GIS Holdings LLC
C/O HIRERIGHT HOLDINGS CORPORATION,
100 CENTERVIEW DRIVE, SUITE 300
NASHVILLE, TN 37214 |
|
X |
|
|
Conrad Jeanne S.
C/O HIRERIGHT HOLDINGS CORPORATION,
100 CENTERVIEW DRIVE, SUITE 300
NASHVILLE, TN 37214 |
|
X |
|
|
Conrad Raymond W.
C/O HIRERIGHT HOLDINGS CORPORATION,
100 CENTERVIEW DRIVE, SUITE 300
NASHVILLE, TN 37214 |
|
X |
|
|
Signatures
|
|
RJC GIS HOLDINGS, LLC By: /s/ Raymond W. Conrad
Name: Raymond W. Conrad Title: President |
|
2/6/2023 |
| **Signature of Reporting
Person |
Date |
|
JEANNE S. CONRAD By: /s/ Jeanne S.
Conrad |
|
2/6/2023 |
| **Signature of Reporting
Person |
Date |
|
RAYMOND W. CONRAD By: /s/ Raymond W.
Conrad |
|
2/6/2023 |
| **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 4(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 control number. |
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