0000899243-21-017419.txt : 20210429
0000899243-21-017419.hdr.sgml : 20210429
20210429184529
ACCESSION NUMBER: 0000899243-21-017419
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210427
FILED AS OF DATE: 20210429
DATE AS OF CHANGE: 20210429
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Leonard Thomas J
CENTRAL INDEX KEY: 0001468016
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40361
FILM NUMBER: 21872821
MAIL ADDRESS:
STREET 1: CAREFUSION CORPORATION
STREET 2: 3750 TORREY VIEW COURT
CITY: SAN DIEGO
STATE: CA
ZIP: 92130
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: AGILITI, INC. \DE
CENTRAL INDEX KEY: 0001749704
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS EQUIPMENT RENTAL & LEASING [7350]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 100 FEDERAL STREET, 35TH FLOOR
CITY: BOSTON
STATE: MA
ZIP: 02110
BUSINESS PHONE: 617-227-1050
MAIL ADDRESS:
STREET 1: 100 FEDERAL STREET, 35TH FLOOR
CITY: BOSTON
STATE: MA
ZIP: 02110
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-04-27
0
0001749704
AGILITI, INC. \DE
AGTI
0001468016
Leonard Thomas J
C/O AGILITI, INC.
6625 WEST 78TH STREET, SUITE 300
MINNEAPOLIS
MN
55439
1
1
0
0
Chief Executive Officer
Common Stock, $0.0001 par value
2021-04-27
4
A
0
86310
0.00
A
1026677
D
Options (Right to Buy)
14.00
2021-04-27
4
A
0
258929
0.00
A
2031-04-27
Common Stock, $0.0001 par value
258929
258929
D
In connection with the issuer's initial public offering, the reporting person received 86,310 restricted share units ("RSUs") under the Agiliti, Inc. Amended and Restated 2018 Omnibus Incentive Plan. The RSUs vest ratably on each of March 6, 2022, March 6, 2023 and March 6, 2024, subject to the reporting person remaining in continuous employment with the issuer on the vesting date.
In connection with the issuer's initial public offering, the reporting person received 258,929 options under the Agiliti, Inc. Amended and Restated 2018 Omnibus Incentive Plan. The options vest ratably on each of March 6, 2022, March 6, 2023 and March 6, 2024, subject to the reporting person remaining in continuous employment with the issuer on the vesting date.
/s/ Lee M. Neumann, by power of attorney
2021-04-29