0000899243-21-017424.txt : 20210429 0000899243-21-017424.hdr.sgml : 20210429 20210429184743 ACCESSION NUMBER: 0000899243-21-017424 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: Christensen Scott A CENTRAL INDEX KEY: 0001756254 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40361 FILM NUMBER: 21872829 MAIL ADDRESS: STREET 1: C/O UNIVERSAL HOSPITAL SERVICES, INC. STREET 2: 6625 WEST 78TH ST, SUITE 300 CITY: MINNEAPOLIS STATE: MN ZIP: 55439 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 0001756254 Christensen Scott A C/O AGILITI, INC. 6625 WEST 78TH STREET, SUITE 300 MINNEAPOLIS MN 55439 0 1 0 0 VP, Controller & CAO Common Stock, $0.0001 par value 2021-04-27 4 P 0 500 14.00 A 30158 D Common Stock, $0.0001 par value 2021-04-27 4 A 0 3214 0.00 A 33372 D Options (Right to Buy) 14.00 2021-04-27 4 A 0 9643 0.00 A 2031-04-27 Common Stock, $0.0001 par value 9643 9643 D The purchase reported in this Form 4 was effected pursuant to a directed share program held by the issuer in connection with its initial public offering. In connection with the issuer's initial public offering, the reporting person received 3,214 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 9,643 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