0000899243-21-046177.txt : 20211126 0000899243-21-046177.hdr.sgml : 20211126 20211126180024 ACCESSION NUMBER: 0000899243-21-046177 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211123 FILED AS OF DATE: 20211126 DATE AS OF CHANGE: 20211126 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LARSEN JOHN L CENTRAL INDEX KEY: 0001065871 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39439 FILM NUMBER: 211452380 MAIL ADDRESS: STREET 1: C/O ATI PHYSICAL THERAPY STREET 2: 790 REMINGTON BLVD. CITY: BOLINGBROOK STATE: IL ZIP: 60440-4909 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ATI Physical Therapy, Inc. CENTRAL INDEX KEY: 0001815849 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-NURSING & PERSONAL CARE FACILITIES [8050] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 790 REMINGTON BOULEVARD CITY: BOILINGBROOK STATE: IL ZIP: 60440 BUSINESS PHONE: 702-844-6111 MAIL ADDRESS: STREET 1: 790 REMINGTON BOULEVARD CITY: BOILINGBROOK STATE: IL ZIP: 60440 FORMER COMPANY: FORMER CONFORMED NAME: Fortress Value Acquisition Corp. II DATE OF NAME CHANGE: 20200622 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-11-23 0 0001815849 ATI Physical Therapy, Inc. ATIP 0001065871 LARSEN JOHN L C/O ATI PHYSICAL THERAPY 790 REMINGTON BOULEVARD BOLINGBROOK IL 60440 1 1 0 0 Executive Chairman Class A common stock 2021-11-23 4 A 0 88450 0.00 A 88450 D Stock Option (right to buy) 3.42 2021-11-23 4 A 0 34952 0.00 A 2031-11-23 Class A common stock 34952 34952 D Stock Option (right to buy) 3.42 2021-11-23 4 A 0 134216 0.00 A 2031-11-23 Class A common stock 134216 169168 D One-third of the Stock Options vest on each of the first three anniversaries of June 16, 2021, each subject to the Reporting Person's continued service through the applicable vesting date. One-third of the Stock Options vest on each of the first three anniversaries of August 9, 2021, each subject to the Reporting Person's continued service through the applicable vesting date. /s/ Erik Kantz, as Attorney-In-Fact for Reporting Person 2021-11-26