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*
Danone Manifesto Ventures, PBC

(Last) (First) (Middle)
12 WEST 21ST STREET
12TH FLOOR

(Street)
NEW YORK NY 10010

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/22/2020
3. Issuer Name and Ticker or Trading Symbol
Laird Superfood, Inc. [ LSF ]
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)
Form filed by One Reporting Person
X 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
Series B-1 Preferred Stock (1) (1) Common Stock 766,284 (1) I See Explanation of Responses(2)
1. Name and Address of Reporting Person*
Danone Manifesto Ventures, PBC

(Last) (First) (Middle)
12 WEST 21ST STREET
12TH FLOOR

(Street)
NEW YORK NY 10010

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Danone S.A.

(Last) (First) (Middle)
17 BOULEVARD HAUSSMANN

(Street)
PARIS I0

(City) (State) (Zip)
Explanation of Responses:
1. Each share of the Company's Series B-1 Preferred Stock is convertible on a one-to-two basis into shares of the Company's common stock at the holder's election and has no expiration date. The Series B-1 Preferred Stock will automatically convert into common stock upon the closing of the Company's initial public offering.
2. Danone Manifesto Ventures, PBC is the direct holder of the shares of Series B-1 Preferred Stock reflected in this Form 3. Danone Manifesto Ventures, PBC is a wholly owned subsidiary of Danone North America Public Benefit Corporation, which is a wholly owned subsidiary of Compagnie Gervais Danone S.A., which is a wholly owned subsidiary of Danone S.A. Danone S.A. is an indirect beneficial owner of the reported securities.
Remarks:
/s/ Laurent Marcel, Danone Manifesto Ventures, PBC 09/22/2020
/s/ Cecile Cabanis, Danone S.A. 09/22/2020
** 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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