SEC FORM 3 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*
Litkovitz Mark E.

(Last) (First) (Middle)
C/O APRIA INC. 7353 COMPANY DRIVE

(Street)
INDIANAPOLIS IN 46237

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/11/2021
3. Issuer Name and Ticker or Trading Symbol
Apria, Inc. [ APR ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP, Chief Information Officer
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)
Common Stock 14,197 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
Stock Appreciation Rights (1) 03/09/2027 Common Stock 9,373 2.07 D
Stock Appreciation Rights (2) 06/05/2025 Common Stock 2,164 4.67 D
Stock Appreciation Rights (2) 03/09/2027 Common Stock 11,250 4.67 D
Stock Appreciation Rights (3) 10/08/2029 Common Stock 17,249 5.33 D
Stock Appreciation Rights (4) 05/12/2030 Common Stock 22,999 5.33 D
Stock Appreciation Rights (2) 02/20/2025 Common Stock 38,942 8.28 D
Stock Appreciation Rights (2) 06/05/2025 Common Stock 8,697 8.28 D
Stock Appreciation Rights (2) 03/09/2027 Common Stock 16,889 8.28 D
Stock Appreciation Rights (2) 10/08/2029 Common Stock 5,751 8.28 D
Explanation of Responses:
1. These stock appreciation rights vest in equal quarterly installments ending on March 1, 2022.
2. These stock appreciation rights are fully vested.
3. These stock appreciation rights vest in equal quarterly installments until August 15, 2024.
4. These stock appreciation rights vest as follows: (a) 20% vests on May 12, 2021, and (b) the remaining vests in equal quarterly installments ending on May 12, 2025.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney.
/s/ Raoul Smyth, as Attorney-in-Fact 02/11/2021
** 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.
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.
                               POWER OF ATTORNEY

Know all by these presents that the undersigned, does hereby make, constitute
and appoint each of Debra L. Morris, Raoul Smyth and Doreen Bellucci, or any one
of them, as a true and lawful attorney-in-fact of the undersigned with full
powers of substitution and revocation, for and in the name, place and stead of
the undersigned (in the undersigned's individual capacity), to execute and
deliver such forms that the undersigned may be required to file with the U.S.
Securities and Exchange Commission as a result of the undersigned's ownership of
or transactions in securities of Apria Inc. (the "Company") (i) pursuant to
Section 16(a) of the Securities Exchange Act of 1934, as amended, including
without limitation, statements on Form 3, Form 4 and Form 5 (including any
amendments thereto) and (ii) in connection with any applications for EDGAR
access codes or any other documents necessary or appropriate to obtain codes and
passwords enabling the undersigned to make electronic filings with the
Securities and Exchange Commission, including without limitation the Form ID.
The Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with regard to his or
her ownership of or transactions in securities of the Company, unless earlier
revoked in writing. Debra L. Morris, Raoul Smyth and Doreen Bellucci are not
assuming any of the undersigned's responsibilities to comply with Section 16 of
the Securities Exchange Act of 1934, as amended.

                                        By: /s/ Mark E. Litkovitz
                                            ------------------------------
                                        Name: Mark E. Litkovitz

                                        Date: January 24, 2021