Initial Statement of Beneficial Ownership (3)
June 28 2021 - 04:31PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE
COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP
OF SECURITIES
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OMB
APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response... 0.5 |
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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 * ADVENT INTERNATIONAL
CORP/MA |
2. Date of Event Requiring Statement
(MM/DD/YYYY)
6/16/2021
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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)
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(Street)
BOSTON, MA 02199
(City)
(State)
(Zip)
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5. If Amendment, Date Original
Filed(MM/DD/YYYY)
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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
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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)
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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
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Director |
10% Owner |
Officer |
Other |
ADVENT INTERNATIONAL CORP/MA
PRUDENTIAL TOWER, 800 BOYLSTON STREET,
SUITE 3300
BOSTON, MA 02199 |
|
X |
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Advent Partners GPE VII-B Cayman Limited
Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
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X |
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Advent Partners GPE VII Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
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X |
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Advent Partners GPE VII-A Cayman Limited
Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
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X |
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Advent Partners GPE VII-A Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
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X |
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GPE VII ATI Co-Investment Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
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X |
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Advent International GPE VII, LLC
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
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X |
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Maldonado John L.
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
X |
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|
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Petrone Carmine
C/O ADVENT INTERNATIONAL CORPORATION
800 BOYLSTON STREET, SUITE 3300
BOSTON, MA 02199 |
X |
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Signatures
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Advent International Corporation, /s/ James
Westra, Name: James Westra, Title: General Counsel and Managing
Partner |
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6/28/2021 |
**Signature of Reporting
Person |
Date |
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