0001104659-19-000912.txt : 20190104
0001104659-19-000912.hdr.sgml : 20190104
20190104193426
ACCESSION NUMBER: 0001104659-19-000912
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190104
FILED AS OF DATE: 20190104
DATE AS OF CHANGE: 20190104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gottlieb Gary L.
CENTRAL INDEX KEY: 0001680825
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38153
FILM NUMBER: 19511858
MAIL ADDRESS:
STREET 1: 1 VAN DE GRAAFF DRIVE
CITY: BURLINGTON
STATE: MA
ZIP: 01803
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Federal Street Acquisition Corp.
CENTRAL INDEX KEY: 0001701821
STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: C/O THOMAS H LEE PARTNERS, L.P.
STREET 2: 100 FEDERAL STREET, 35TH FLOOR
CITY: BOSTON
STATE: MA
ZIP: 02110
BUSINESS PHONE: 617-227-1050
MAIL ADDRESS:
STREET 1: C/O THOMAS H LEE PARTNERS, L.P.
STREET 2: 100 FEDERAL STREET, 35TH FLOOR
CITY: BOSTON
STATE: MA
ZIP: 02110
4
1
a4.xml
4
X0306
4
2019-01-04
1
0001701821
Federal Street Acquisition Corp.
FSAC
0001680825
Gottlieb Gary L.
C/O THOMAS H. LEE PARTNERS, L.P.
100 FEDERAL STREET, 35TH FLOOR
BOSTON
MA
02210
1
0
0
0
Class A Common Stock, par value $0.0001 per share
2019-01-04
4
C
0
25000
A
25000
D
Class A Common Stock, par value $0.0001 per share
2019-01-04
4
D
0
25000
D
0
D
Class F Common Stock, par value $0.0001 per share
2019-01-04
4
C
0
25000
D
Class A Common Stock, par value $0.0001 per share
25000
0
D
Pursuant to the Amended and Restated Certificate of Incorporation of the Issuer, the shares of the Issuer's Class F Common Stock, par value $0.0001 per share ("Class F Common Stock"), automatically converted into shares of the Issuer's Class A Common Stock, par value $0.0001 per share ("Class A Common Stock"), on a one-for-one basis, on January 4, 2019 at the time of the Issuer's initial business combination. The Class F Common Stock had no expiration date.
In accordance with the Amended and Restated Agreement and Plan of Merger, dated as of December 19, 2018 by and among the Issuer, Agiliti, Inc., Agiliti Holdco, Inc. and the other parties thereto, at the closing of the business combination contemplated thereby, Mr. Gottlieb disposed of 25,000 shares of the Issuer's Class A Common Stock in exchange for 25,000 shares of common stock of Agiliti, Inc.
/s/ Charles P. Holden, Attorney-in-Fact
2019-01-04