Initial Statement of Beneficial Ownership (3)
June 28 2021 - 4:31PM
Edgar (US Regulatory)
FORM 3
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
|
1. Name and Address of Reporting Person
*
ADVENT INTERNATIONAL CORP/MA |
2. Date of Event Requiring Statement (MM/DD/YYYY)
6/16/2021
|
3. Issuer Name and Ticker or Trading Symbol
ATI Physical Therapy, Inc. [ATIP]
|
|
(Last)
(First)
(Middle)
PRUDENTIAL TOWER, 800 BOYLSTON STREET,, SUITE 3300 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director ___X___ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
|
|
(Street)
BOSTON, MA 02199
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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) |
| Class A Common Stock, par value $0.0001 per share | 130300000 (1) | I | See Footnotes (2)(4) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
| Earnout Shares | (3) | (3) | Class A Common Stock, par value $0.0001 per share | 15000000 | (3) | I | See notes (2)(4) |
| Explanation of Responses: |
| (1) | See Exhibit 99.1 for text of footnote (1) |
| (2) | See Exhibit 99.1 for text of footnote (2) |
| (3) | See Exhibit 99.1 for text of footnote (3) |
| (4) | See Exhibit 99.1 for text of footnote (4) |
Remarks:
Exhibit 99.1 (Signatures and Joint Filer Information) and Exhibit 99.2 (Joint Filer Information) are incorporated herein by reference. This Form 3 is the third of three Forms 3 being filed relating to the same event. The Form 3 has been split into three filings because there are more than 10 Reporting Persons in total, and the SEC's EDGAR filing system limits a single Form 3 to a maximum of 10 Reporting Persons. Each Form 3 will be filed by Designated Filer Advent International Corporation.
Form 3 of 3 |
Reporting Owners
|
| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
ADVENT INTERNATIONAL CORP/MA
PRUDENTIAL TOWER, 800 BOYLSTON STREET,
SUITE 3300
BOSTON, MA 02199 |
| X |
|
|
Advent Partners GPE VII-B Cayman Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
| X |
|
|
Advent Partners GPE VII Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
| X |
|
|
Advent Partners GPE VII-A Cayman Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
| X |
|
|
Advent Partners GPE VII-A Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
| X |
|
|
GPE VII ATI Co-Investment Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
| X |
|
|
Advent International GPE VII, LLC
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
| X |
|
|
Maldonado John L.
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 | X |
|
|
|
Petrone Carmine
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 | X |
|
|
|
Signatures
|
| Advent International Corporation, /s/ James Westra, Name: James Westra, Title: General Counsel and Managing Partner | | 6/28/2021 |
| **Signature of Reporting Person | Date |
ATI Physical Therapy (NYSE:ATIP)
Historical Stock Chart
From Mar 2024 to Apr 2024
ATI Physical Therapy (NYSE:ATIP)
Historical Stock Chart
From Apr 2023 to Apr 2024
