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Anbari David – ‘3’ for 7/1/22 re: Agiliti, Inc./DE

On:  Monday, 7/11/22, at 4:39pm ET   ·   For:  7/1/22   ·   As:  Officer   ·   Accession #:  1415889-22-7630   ·   File #:  1-40361

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 7/11/22  Anbari David                      3          Officer     2:12K  Agiliti, Inc./DE                  SEC Connect

Initial Statement of Beneficial Ownership of Securities by an Insider   —   Form 3   —   SEA’34

Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 3           Initial Statement of Beneficial Ownership of        HTML      8K 
                Securities by an Insider --                                      
                form3-07112022_010719.xml/2.6                                    
 2: EX-24       Power of Attorney                                   HTML      8K 


‘3’   —   Initial Statement of Beneficial Ownership of Securities by an Insider — form3-07112022_010719.xml/2.6




        

This ‘3’ Document is an XML Data File that may be rendered in various formats:

  Form 3    –   Plain Text   –  SEC Website  –  EDGAR System  –    XML Data    –  <?xml?> File
 

 
SEC Info rendering:  Initial Statement of Beneficial Ownership of Securities by an Insider — form3-07112022_010719.xml/2.6
 
FORM 3UNITED 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
OMB APPROVAL
OMB Number:3235-0104
Estimated average burden
hours per response:0.5
1. Name and Address of Reporting Person*
ANBARI DAVID

(Last)(First)(Middle)
C/O AGILITI, INC.
11095 VIKING DRIVE, SUITE 300

(Street)
EDEN PRAIRIEMN55344

(City)(State)(Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
7/1/22
3. Issuer Name and Ticker or Trading Symbol
AGILITI, INC. \DE [ AGTI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
XOfficer (give title below) Other (specify below)
SVP, STRTGY & SOLUT'N MGMT
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
XForm 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, $0.0001 par value47,602D
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 ExercisableExpiration DateTitleAmount or Number of Shares
Options (Right to Buy) (1) 3/6/30Common Stock, $0.0001 par value81,8188.25D
Options (Right to Buy) (2) 3/6/30Common Stock, $0.0001 par value21,2128.25D
Options (Right to Buy) (3) 4/22/31Common Stock, $0.0001 par value17,50014D
Options (Right to Buy) (4) 3/3/32Common Stock, $0.0001 par value21,40918.45D
Explanation of Responses:
(1)  These options were granted under Agiliti, Inc.'s 2018 Omnibus Incentive Plan on March 6, 2020. These options vest ratably on an annual basis over a four-year period.
(2)  These options were granted under Agiliti, Inc.'s 2018 Omnibus Incentive Plan on March 6, 2020. These options vest ratably on an annual basis over a three-year period.
(3)  These options were granted under Agiliti, Inc.'s 2018 Omnibus Incentive Plan on April 22, 2021. These options vest ratably on an annual basis over a three-year period.
(4)  These options were granted under Agiliti, Inc.'s 2018 Omnibus Incentive Plan on March 3, 2022. These options vest ratably on an annual basis over a three-year period.
/s/ Lee M. Neumann, by power of attorney 7/11/22
** Signature of Reporting PersonDate
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).
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.

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