Amended Statement of Changes in Beneficial Ownership (4/a)
May 06 2021 - 7:13PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Lam Thomas S. |
2. Issuer Name and Ticker or Trading Symbol
Apollo Medical Holdings, Inc.
[
AMEH
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
President and Co-CEO |
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(Last)
(First)
(Middle)
1668 S. GARFIELD AVE., 2ND FL. |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/22/2020 |
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(Street)
ALHAMBRA, CA 91801
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
4/1/2021 |
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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common Stock | 12/22/2020 | | J(1) | | 185938 (1) | A(1) | $0 | 876428 (2) | I | By the Thomas and Jeanette Lam 2002 Family Trust |
| Common Stock | 3/30/2021 | | M | | 31755 | A | $10 | 908183 (2) | I | By the Thomas and Jeanette Lam 2002 Family Trust |
| Common Stock | | | | | | | | 126585 | D | |
| Common Stock | | | | | | | | 564691 (3) | I | By grantor retained annuity trust |
| Common Stock | | | | | | | | 564691 (4) | I | By wife |
| Common Stock | | | | | | | | 10887594 (5) | I | By Allied Physicians of California, a Professional Medical Corporation |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security
(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) |
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Explanation of Responses: |
| (1) | Represents the receipt of shares of the issuer pursuant to a pro rata in-kind distribution by Allied Physicians of California, A Profession Medical Corporation ("Allied") of which the Reporting Person is a director, officer and shareholder. |
| (2) | These securities are held by the Thomas and Jeanette Lam 2002 Family Trust U/A dated 09/06/2002. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the filing of this report is not an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose. |
| (3) | These securities are held by a grantor retained annuity trust for the benefit of the Reporting Person and his children. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. |
| (4) | These securities are beneficially owned by the Reporting Person's spouse as separate property. The Reporting Person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. |
| (5) | These securities are beneficially owned by Allied, of which the Reporting Person is a director, officer and shareholder. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the filing of this report is not an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Lam Thomas S.
1668 S. GARFIELD AVE., 2ND FL.
ALHAMBRA, CA 91801 | X |
| President and Co-CEO |
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Signatures
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| /s/ Thomas S. Lam | | 5/6/2021 |
| **Signature of Reporting Person | Date |
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