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).
  
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
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)
02/05/2024
4. 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 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
Common Stock 02/05/2024 A 71,339(1) A $0 237,611 D
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
Explanation of Responses:
1. These shares represent restricted stock units and will be settled in common stock upon vesting.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Shannone Raybon, as attorney-in-fact for Shaw Rietkerk*** 02/07/2024
** 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.

Exhibit 24

 

SUBSTITUTE POWER OF ATTORNEY

 

July 31, 2023

 

Reference is made to those certain Powers of Attorney executed over a period of several years, copies of which were previously filed with the Securities and Exchange Commission (the “Original Powers of Attorney”), by and between the undersigned, Christopher Joyce (the Original Attorney-in- Fact”) and each of the directors and officers of AdaptHealth Corp. (the “Company”) set forth below (collectively, the “Section 16 Reporting Persons”), pursuant to which the Original Attorney-in-Fact was appointed the true and lawful attorney-in-fact, with full power of substitution, to do and perform any and all acts which may be necessary or desirable to be done in the exercise of the rights and powers granted in the Original Powers of Attorney:

 

Christine Archbold

Richard Barasch

Gregory Belinfanti

Daniel Bunting

Jason Clemens

Terence Connors

Bradley Coppens

Stephen Griggs

Josh Parnes

Albert Prast

Shaw Rietkerk

Susan Weaver

David Williams

Dale Wolf

 

In accordance with the authority granted under the Original Powers of Attorney, the Original Attorney-in- Fact hereby constitutes and appoints Shannone Raybon (the “Substitute Attorney-in-Fact”) as a substitute attorney-in-fact, on behalf of each of the Section 16 Reporting Persons, with full power of substitution or revocation, to exercise and execute all of the powers granted or conferred in the Original Powers of Attorney. By her signature as attorney-in-fact to this Substitute Power of Attorney, the Substitute Attorney-in-Fact accepts such appointment and agrees to assume from the undersigned any and all duties and responsibilities attendant to her capacity as attorney-in-fact for each of the Section 16 Reporting Persons. In accordance with the authority granted under the Original Powers of Attorney, including the power of revocation, the undersigned hereby revokes the Original Attorney-in-Fact’s appointment as attorney-in-fact on behalf of each of the Section 16 Reporting Persons.

 

[Signature Page Follows]

 

 

 

 

IN WITNESS WHEREOF, the parties hereto have caused this Substitute Power of Attorney to be duly executed as of the day and year first above written.

 

ORIGINAL ATTORNEY-IN-FACT  
   
   
/s/ Christopher Joyce  
Christopher Joyce  
   
   
I hereby accept this appointment and substitution:  
   
   
/s/ Shannone Raybon  
Shannone Raybon  

 

[Signature Page to Substitute Power of Attorney]

 

 

 


Exhibit 24

 

SUBSTITUTE POWER OF ATTORNEY

 

July 31, 2023

 

Reference is made to those certain Powers of Attorney executed over a period of several years, copies of which were previously filed with the Securities and Exchange Commission (the “Original Powers of Attorney”), by and between the undersigned, Christopher Joyce (the Original Attorney-in- Fact”) and each of the directors and officers of AdaptHealth Corp. (the “Company”) set forth below (collectively, the “Section 16 Reporting Persons”), pursuant to which the Original Attorney-in-Fact was appointed the true and lawful attorney-in-fact, with full power of substitution, to do and perform any and all acts which may be necessary or desirable to be done in the exercise of the rights and powers granted in the Original Powers of Attorney:

 

Christine Archbold

Richard Barasch

Gregory Belinfanti

Daniel Bunting

Jason Clemens

Terence Connors

Bradley Coppens

Stephen Griggs

Josh Parnes

Albert Prast

Shaw Rietkerk

Susan Weaver

David Williams

Dale Wolf

 

In accordance with the authority granted under the Original Powers of Attorney, the Original Attorney-in- Fact hereby constitutes and appoints Shannone Raybon (the “Substitute Attorney-in-Fact”) as a substitute attorney-in-fact, on behalf of each of the Section 16 Reporting Persons, with full power of substitution or revocation, to exercise and execute all of the powers granted or conferred in the Original Powers of Attorney. By her signature as attorney-in-fact to this Substitute Power of Attorney, the Substitute Attorney-in-Fact accepts such appointment and agrees to assume from the undersigned any and all duties and responsibilities attendant to her capacity as attorney-in-fact for each of the Section 16 Reporting Persons. In accordance with the authority granted under the Original Powers of Attorney, including the power of revocation, the undersigned hereby revokes the Original Attorney-in-Fact’s appointment as attorney-in-fact on behalf of each of the Section 16 Reporting Persons.

 

[Signature Page Follows]

 

 

 

 

IN WITNESS WHEREOF, the parties hereto have caused this Substitute Power of Attorney to be duly executed as of the day and year first above written.

 

ORIGINAL ATTORNEY-IN-FACT  
   
   
/s/ Christopher Joyce  
Christopher Joyce  
   
   
I hereby accept this appointment and substitution:  
   
   
/s/ Shannone Raybon  
Shannone Raybon  

 

[Signature Page to Substitute Power of Attorney]

 

 

 


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