SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Rietkerk Shaw

(Last) (First) (Middle)
C/O ADAPTHEALTH LLC
220 WEST GERMANTOWN PIKE, SUITE 250

(Street)
PLYMOUTH MEETING PA 19462

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
AdaptHealth Corp. [ AHCO ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Operating Officer
3. Date of Earliest Transaction (Month/Day/Year)
01/28/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
02/01/2021
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) $11.5 01/28/2021 A 208,333(1) (1) 12/19/2029 Class A Common Stock 208,333 $0 208,333 D
Explanation of Responses:
1. On December 19, 2019, the reporting person was granted an option to purchase 208,333 shares of Class A Common Stock of the issuer, subject to the issuer's satisfaction of certain performance criteria for the fiscal year ended December 31, 2020. The performance criteria for 2020 were met, resulting in the vesting of the option as to 208,333 shares in three equal annual installments on each of December 31, 2020, December 31, 2021 and December 31, 2022. This amendment is being filed to correct inadvertent typographical errors in the number of shares vested under the option held by the reporting person.
Remarks:
*** The Power of Attorney given by the reporting person was previously filed with the U.S. Securities and Exchange Commission on November 13, 2019 as an exhibit to the Form 3 filed by the reporting person with respect to the Issuer and is hereby incorporated by reference.
Chris Joyce , as attorney-in-fact for Shaw Rietkerk*** 02/12/2021
** 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 4 (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.