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