Initial Statement of Beneficial Ownership (3)
June 04 2020 - 5:52PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Sim Brandon |
2. Date of Event Requiring Statement (MM/DD/YYYY)
5/26/2020
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3. Issuer Name and Ticker or Trading Symbol
Apollo Medical Holdings, Inc. [AMEH]
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(Last)
(First)
(Middle)
1668 S. GARFIELD AVENUE, 2ND FLOOR |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Interim Co-COO / |
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(Street)
ALHAMBRA, CA 91801
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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 | 36663 (1)(2) | D | |
| Common Stock | 2000 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 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) |
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Explanation of Responses: |
| (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. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Sim Brandon
1668 S. GARFIELD AVENUE
2ND FLOOR
ALHAMBRA, CA 91801 |
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| Interim Co-COO |
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Signatures
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| /s/ Brandon Sim | | 6/3/2020 |
| **Signature of Reporting Person | Date |
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