SEC Form 3
FORM 3 UNITED 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
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1. Name and Address of Reporting Person*
Scott Gregory W.

(Last) (First) (Middle)
C/O ADEPTUS HEALTH INC.
2941 SOUTH LAKE VISTA

(Street)
LEWISVILLE TX 75067

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/25/2014
3. Issuer Name and Ticker or Trading Symbol
Adeptus Health Inc. [ ADPT ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. 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 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)
Class A Common Stock 1,705(1) D
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 Exercisable Expiration Date Title Amount or Number of Shares
Units of Adeptus Health LLC(2) (3) (3) Class A Common Stock 30,214(3) (2) D
Explanation of Responses:
1. Represents a grant of restricted shares of Class A Common Stock.
2. Units of Adeptus Health LLC represent limited liability company units of Adeptus Health LLC and an equal number of shares of Class B Common Stock of Adeptus Health Inc., which together are exchangeable on a one-for-one basis for shares of Class A Common Stock of Adeptus Health Inc. pursuant to the Amended and Restated Limited Liability Company Agreement of Adeptus Health LLC.
3. Represents Units of Adeptus Health LLC that were granted in the form of restricted units, which are subject to time-based vesting criteria, whereby 25% vested and became exchangeable on April 24, 2014, and 75% vest and become exchangeable ratably on a quarterly basis during the three-year period following the initial vesting date.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Jeffrey Vines, attorney-in-fact 06/25/2014
** 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 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.
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