4: Statement of changes in beneficial ownership of securities
Published on December 30, 2019
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
(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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Option (right to buy) | $ 18.65 (2) | 12/30/2019 | A(2) | 28,046 | (2) | 12/30/2024 | Common Stock | 28,046 | $ 0 | 28,046 | D |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Lam Thomas S. 1668 GARFIELD AVE., 2ND FLOOR ALHAMBRA, CA 91801 |
X | President and Co-CEO |
Signatures
/s/ by Omar Dabuni as attorney-in-fact for Thomas Lam, M.D. | 12/30/2019 | |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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). |
(1) | Restricted shares of Common Stock of Apollo Medical Holdings, Inc. (the "Company") granted under the Company's 2015 Equity Incentive Plan, subject to vesting one-third after year one (on December 30, 2020), one-third after year two (on December 30, 2021), and the final one-third after year three (on December 30, 2022). |
(2) | Stock option to purchase the Company's Common Stock granted under the Company's 2015 Equity Incentive Plan, which stock option will vest and become exercisable one-third after year one (on December 30, 2020), one-third after year two (on December 30, 2021), and the final one-third after year three (on December 30, 2022), subject to expiration on the date that is five years from the date of grant (i.e., on December 30, 2024). The exercise price for each share subject to the stock option granted shall be set at the closing price of the Company's Common Stock on the date the grant was approved by the Company. |