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
 
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Brauser Michael

(Last) (First) (Middle)
C/O RED VIOLET, INC.
2650 N. MILITARY TRAIL, SUITE 300

(Street)
BOCA RATON FL 33431

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/26/2018
3. Issuer Name and Ticker or Trading Symbol
Red Violet, Inc. [ RDVT ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X 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)
X Form filed by One Reporting Person
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)
Common Stock 863,316(1) D
Common Stock 291,857(1) I See footnote(2)
Common Stock 183,151(1) I See footnote(3)
Common Stock 2,417(1) I See footnote(4)
Common Stock 1,084(1) I See footnote(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
Explanation of Responses:
1. Represents shares received in a pro rata distribution of the outstanding shares of Red Violet, Inc. to the stockholders of Cogint, Inc.
2. Shares held by Grander Holdings, Inc. 401K Profit Sharing Plan of which Mr. Brauser is trustee.
3. Shares held by Birchtree Capital, LLC, of which Mr. Brauser is the manager.
4. Shares held by Betsy and Michael Brauser Charitable Family Foundation, Inc., of which Mr. Brauser is a director.
5. Shares held by BSIG, LLC, of which Mr. Brauser is a member. Mr. Brauser disclaims beneficial ownership of these shares except to the extent of any pecuniary interest he may have.
Remarks:
/s/ Michael Brauser 03/30/2018
** 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.