Ownership Submission
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FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549INITIAL 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
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OMB Number:3235-0104Expires:January 31, 2005Estimated average burden hours per response...0.5
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1. Name and Address of Reporting Person *
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Koch, Inc.
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2. Date of Event Requiring Statement (Month/Day/Year)
2024-08-01
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3. Issuer Name and Ticker or Trading Symbol
Ibotta, Inc. [IBTA]
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(Last)
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(First)
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(Middle)
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4111 E. 37TH STREET NORTH
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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_____ 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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5. If Amendment, Date Original Filed(Month/Day/Year)
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(Street)
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WICHITA
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KS
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67220
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6. Individual or Join/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
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2. Amount of Securities Beneficially Owned
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3. Ownership Form: Direct (D) or Indirect (I)
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4. Nature of Indirect Beneficial Ownership
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
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2. Date Exercisable and Expiration Date
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3. Title and Amount of Securities Underlying Derivative Security
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
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6. Nature of Indirect Beneficial Ownership
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Date Exercisable
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Expriation Date
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Title
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Amount or Number of Shares
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Koch, Inc.
4111 E. 37TH STREET NORTH
WICHITA, KS67220
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Signatures
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Koch, Inc., /s/ Raffaele G. Fazio, Assistant Secretary
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2024-08-02
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**Signature of Reporting Person
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Date
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Explanation of Responses:
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(*)
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If the form is filed by more than one reporting person, see Instruction 5(b)(v).
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(**)
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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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(1)
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KDT Ibotta Holdings, LLC ("KDT Ibotta") is beneficially owned by Koch Disruptive Technologies, LLC ("KDT"), KDT is beneficially owned by Koch Disruptive Technologies Holdings, LLC ("KDT Holdings"), KDT Holdings is beneficially owned by Koch Investments Group, LLC ("KIG"), KIG is beneficially owned by Koch Investments Group Holdings, LLC ("KIGH"), KIGH is beneficially owned by Koch Companies, LLC ("KCLLC"), and KCLLC is beneficially owned by Koch, Inc., in each case by means of ownership of all voting equity instruments. Koch, Inc., KCLLC, KIGH, KIG, KDT Holdings and KDT may be deemed to beneficially own the shares of Class A common stock,
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(2)
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(Continued from footnote 1) par value $0.00001 per share, of Ibotta, Inc. (the "Issuer") held by KDT Ibotta by virtue of (i) Koch, Inc.'s beneficial ownership of KCLLC, (ii) KCLLC's beneficial ownership of KIGH, and (iii) KIGH's beneficial ownership of KIG, (iv) KIG's beneficial ownership of KDT Holdings, (v) KDT Holdings' beneficial ownership of KDT and (vi) KDT's beneficial ownership of KDT Ibotta.
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(3)
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Effective August 1, 2024, pursuant to an internal reorganization, Koch, Inc. became the indirect ultimate parent of KDT Ibotta.
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Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
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