SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
Rubio Beth

(Last) (First) (Middle)
C/O AVEANNA HEALTHCARE HOLDINGS INC
400 INTERSTATE NORTH PARKWAY SE

(Street)
ATLANTA GA 30339

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/28/2021
3. Issuer Name and Ticker or Trading Symbol
Aveanna Healthcare Holdings, Inc. [ AVAH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Clinical Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock, par value $0.01 per share 25,079 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) (1) 12/01/2027 Common Stock 70,987 4.88 D
Employee Stock Option (right to buy) (2) 12/01/2027 Common Stock 70,987 4.88 D
Employee Stock Option (right to buy) (3) 11/24/2030 Common Stock 30,750 15 D
Employee Stock Option (right to buy) (4) 11/24/2030 Common Stock 30,750 15 D
Explanation of Responses:
1. The options vest ratably on an annual basis over a five-year period that commenced March 16, 2017.
2. The options become exercisable, if at all, in two equal increments if the average daily closing price of Aveanna Healthcare Holdings Inc.'s (the "Issuer") common stock on the Nasdaq Global Select Market during any 90 consecutive calendar day period, commencing on or after nine (9)-month anniversary of April 28, 2021, exceeds specified volume-weighted average price targets determined by the Issuer's Board of Directors.
3. The options vest ratably on an annual basis over a five-year period that commenced on November 4, 2020.
4. The options become exercisable, if at all, in two equal increments if the average daily closing price of the Issuer's common stock on the Nasdaq Global Select Market during any 90 consecutive calendar day period, commencing on or after nine (9)-month anniversary of April 28, 2021, exceeds specified volume-weighted average price targets determined by the Issuer's Board of Directors.
Remarks:
See Exhibit 24.1 - Power of Attorney
/s/ Shannon Drake, Attorney-in-Fact 04/28/2021
** 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 5 (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).
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