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

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1. Name and Address of Reporting Person^*

LA ROSA JOSEPH

(Last)

(First)

(Middle)

1420 CELEBRATION BLVD, SUITE 200

(Street)

CELEBRATION,

34747

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
10/04/2023

3. Issuer Name and Ticker or Trading Symbol
La Rosa Holdings Corp. [ LRHC ]

4. 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

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	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 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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Warrant to Purchase Common Stock	12/02/2022	12/02/2027	Common Stock	50,000	$5⁽³⁾	D

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.

	/s/ Joseph La Rosa	10/04/2023
	** 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 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.