4: Statement of changes in beneficial ownership of securities
Published on December 29, 2017
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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) | $ 5 | 10/14/2016(2) | 09/14/2026 | Common Stock, par value $0.001 per share | 20,000 | 140,000 (1) (5) | D | ||||||||
Stock Option (right to buy) | $ 5.79 | 03/15/2016(3) | 02/14/2026 | Common Stock, par value $0.001 per share | 20,000 | 140,000 (1) (5) | D | ||||||||
Stock Option (right to buy) | $ 0.145 | 02/01/2012(4) | 02/01/2022 | Common Stock, par value $0.001 per share | 100,000 | 140,000 (1) (5) | D |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Schreck Edward 700 N. BRAND BLVD. SUITE 1400 GLENDALE, CA 91203 |
Former Director |
Signatures
/s/ Edward Schreck | 12/28/2017 | |
**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) | This form is not filed to reflect any transactions but to disclose that Reporting Person resigned from the board of directors of Apollo Medical Holdings, Inc. ("ApolloMed"), effective as of the closing of a merger between Apollo Acquisition Corp., a wholly owned subsidiary of ApolloMed, and Network Medical Management, Inc., a California corporation, on December 8, 2017, and as a result, is no longer subject to Section 16, Form 4 or Form 5 obligations based on his directorship at ApolloMed. |
(2) | The option vested at the rate of one-twelfth of the shares per month commencing on October 14, 2016. |
(3) | The option vested at the rate of one-twelfth of the shares per month commencing on March 15, 2016. |
(4) | The option vested at the rate of one-third of the shares per year commencing on February 1, 2012. |
(5) | As of December 8, 2017, Reporting Person had direct ownership of stock options with respect to 140,000 shares of common stock of ApolloMed. |