0001209191-12-059510.txt : 20121227
0001209191-12-059510.hdr.sgml : 20121227
20121227172516
ACCESSION NUMBER: 0001209191-12-059510
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20121224
FILED AS OF DATE: 20121227
DATE AS OF CHANGE: 20121227
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Acadia Healthcare Company, Inc.
CENTRAL INDEX KEY: 0001520697
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SPECIALTY OUTPATIENT FACILITIES, NEC [8093]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 725 COOL SPRINGS BOULEVARD
STREET 2: SUITE 600
CITY: FRANKLIN
STATE: TN
ZIP: 37067
BUSINESS PHONE: 615-732-6259
MAIL ADDRESS:
STREET 1: 725 COOL SPRINGS BOULEVARD
STREET 2: SUITE 600
CITY: FRANKLIN
STATE: TN
ZIP: 37067
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: JOEY A. JACOBS 2011 GRANTOR RETAINED ANNUITY TRUST (ACADIA)
CENTRAL INDEX KEY: 0001533983
STATE OF INCORPORATION: TN
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35331
FILM NUMBER: 121288138
BUSINESS ADDRESS:
STREET 1: C/O ACADIA HEALTHCARE COMPANY
STREET 2: 830 CRESCENT CENTRE DR., SUITE 610
CITY: FRANKLIN
STATE: TN
ZIP: 37067
BUSINESS PHONE: 615-861-6000
MAIL ADDRESS:
STREET 1: C/O ACADIA HEALTHCARE COMPANY
STREET 2: 830 CRESCENT CENTRE DR., SUITE 610
CITY: FRANKLIN
STATE: TN
ZIP: 37067
4
1
c30862_4x0.xml
MAIN DOCUMENT DESCRIPTION
X0306
4
2012-12-24
0001520697
Acadia Healthcare Company, Inc.
ACHC
0001533983
JOEY A. JACOBS 2011 GRANTOR RETAINED ANNUITY TRUST (ACADIA)
ACADIA HEALTHCARE COMPANY, INC.
830 CRESCENT CENTRE DRIVE, SUITE 610
FRANKLIN
TN
37067
0
0
1
0
Common Stock
2012-12-24
4
S
0
39927
21.6
D
878519
D
In connection with the merger of Acadia Healthcare Company, Inc. ("Acadia") and PHC, Inc., the reporting person entered into
a stockholders agreement with Acadia and certain other stockholders. As a result, he may 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.
Joey A. Jacobs 2011 Grantor Retained Annuity Trust (Acadia), by /s/ Joey A. Jacobs, its trustee
2012-12-27