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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 04/28/2021 | 3. Issuer Name and Ticker or Trading Symbol Aveanna Healthcare Holdings, Inc. [ AVAH ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) |
Common Stock, par value $0.01 per share | 10,250 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Employee Stock Option (right to buy) | (1) | 06/29/2028 | Common Stock | 354,935 | 4.88 | D | |
Employee Stock Option (right to buy) | (2) | 06/29/2028 | Common Stock | 354,935 | 4.88 | D | |
Employee Stock Option (right to buy) | (3) | 11/24/2030 | Common Stock | 51,250 | 15 | D | |
Employee Stock Option (right to buy) | (4) | 11/24/2030 | Common Stock | 51,250 | 15 | D |
Explanation of Responses: |
1. The options vest ratably on an annual basis over a five-year period that commenced February 6, 2018. |
2. The options become exercisable, if at all, in two equal increments if the average daily closing price of Aveanna Healthcare Holdings Inc.'s (the "Issuer") common stock on the Nasdaq Global Select Market during any 90 consecutive calendar day period, commencing on or after nine (9)-month anniversary of April 28, 2021, exceeds specified volume-weighted average price targets determined by the Issuer's Board of Directors |
3. The options vest ratably on an annual basis over a five-year period that commenced on November 4, 2020. |
4. The options become exercisable, if at all, in two equal increments if the average daily closing price of the Issuer's common stock on the Nasdaq Global Select Market during any 90 consecutive calendar day period, commencing on or after nine (9)-month anniversary of April 28, 2021, exceeds specified volume-weighted average price targets determined by the Issuer's Board of Directors. |
Remarks: |
See Exhibit 24.1 - Power of Attorney |
/s/ Shannon Drake, Attorney-in-Fact | 04/28/2021 | |
** 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. |