Sec Form 3 Filing - LA ROSA JOSEPH @ La Rosa Holdings Corp. - 2023-10-04

Insider filing report for Changes in Beneficial Ownership
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FORM 3
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
LA ROSA JOSEPH
2. Issuer Name and Ticker or Trading Symbol
La Rosa Holdings Corp. [ LRHC]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
President, CEO, and Chairman
(Last) (First) (Middle)
1420 CELEBRATION BLVD, SUITE 200
3. Date of Earliest Transaction (MM/DD/YY)
10/04/2023
(Street)
CELEBRATION,, FL34747
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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)
Code V Amount (A) or (D) Price
Common Stock 5,400,000 D
Series A Convertible Preferred Stock 1,321 ( 1 ) D
Series X Super Voting Preferred Stock 2,000 ( 2 ) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant to Purchase Common Stock $ 5 ( 3 ) 12/02/2022 12/02/2027 Common Stock 50,000 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
LA ROSA JOSEPH
1420 CELEBRATION BLVD, SUITE 200
CELEBRATION,, FL34747
X X President, CEO, and Chairman
Signatures
/s/ Joseph La Rosa 10/04/2023
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Series A Convertible Preferred Stock, $0.0001 par value per share, will automatically convert into shares of the Company's common stock at a 30% discount to the per share price on the date of closing of the Company's initial public offering made pursuant to its registration statement, as amended (File No. 333-264372), as filed with the Securities and Exchange Commission.
( 2 )The Series X Super Voting Preferred Stock that has 10,000 votes per share and votes together as a class with the Company's common stock.
( 3 )Pursuant to the terms of the warrant, the "Exercise Price" is the lower of: (i) $5.00 per share of common stock, or (ii) the price per share of any offering by the Company subsequent to the Company's initial public offering made pursuant to its registration statement, as amended (File No. 333-264372), as filed with the Securities and Exchange Commission, subject to adjustment as provided in the warrant.

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).
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