SEC Form 5 · accession 0001209191-15-013019
Acadia Healthcare Company, Inc. · ACHC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jack E Polson
10% Owner
Period of report
Dec 31, 2014
Accepted (ET)
Feb 12, 2015 · 6:45 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001520697
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Nov 25, 2014 | G | 1,600 | $0.00 | D | 144,859 | D | |
| Common StockF1,F2 | holding | — | — | — | 51,084 | I | See Footnote |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Mr. Polson expressly disclaims beneficial ownership of the reported securities, except to the extent of his pecuniary interest therein.
- F2By the Jack E. Polson Family 2013 Grantor Retained Annuity Trust.
Remarks
The reporting person is party to a stockholders agreement with Acadia Healthcare Company, Inc. ("Acadia") and certain other stockholders. As a result, he may be deemed to be a part of a "group" with such other stockholders. To the extent the reporting person is deemed a member of a group, he disclaims beneficial ownership of shares owned by other members of the group.