3: Initial statement of beneficial ownership of securities
Published on June 4, 2020
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Sim Brandon 1668 S. GARFIELD AVENUE 2ND FLOOR ALHAMBRA, CA 91801 |
Interim Co-COO |
Signatures
/s/ Brandon Sim | 06/03/2020 | |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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). |
(1) | The issuer previously granted 44,589 shares of restricted stock to the reporting person pursuant to the Apollo Medical Holdings, Inc. 2015 Equity Incentive Plan, under which 22,285 shares vested on May 31, 2020 and 22,284 shares shall vest on May 31, 2021, and which grant is accompanied by a tax-offset right entitling the reporting person to receive, upon vesting, a cash payment equal to the tax withholding incurred upon the vesting of shares. |
(2) | Represents the grant of 44,589 shares of restricted stock, less 7,906 shares surrendered to offset against withholding tax liability incurred in connection with vesting of shares on May 31, 2020. |