Statement of Changes in Beneficial Ownership (4)
September 28 2021 - 4:35PM
Edgar (US Regulatory)
FORM 4
[X]
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
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Clifford Kenneth F |
2. Issuer Name and Ticker or Trading Symbol
Amplitude Healthcare Acquisition Corp
[
JSPR
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
_____ Officer (give title below) __X__ Other (specify below)
FORMER OFFICER |
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(Last)
(First)
(Middle)
C/O AMPLITUDE HEALTHCARE HOLDINGS LLC, 1177 AVENUE OF THE AMERICAS, FL 40 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/24/2021 |
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(Street)
NEW YORK, NY 10036
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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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| Voting Common Stock | 9/24/2021 | | M(2) | | 2300000 | A | (1)(2) | 2300000 | I | See Footnote (4) |
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 |
| Class B Common Stock | (3) | 9/24/2021 | | D | | 200000 | | (1) | (1) | Class A Common Stock | 200000 | $0.00 | 0 | I | See Footnote (4) |
| Class B Common Stock | (1)(2) | 9/24/2021 | | M (2) | | 2300000 | | (1) | (1) | Class A Common Stock | 2300000 | (2) | 0 | I | See Footnote (4) |
| Explanation of Responses: |
| (1) | As described in the Issuer's registration statement on Form S-1 (File No. 333-234324) under the heading "Description of Securities--Founder Shares", the shares of Class B Common Stock will automatically convert into shares of Class A Common Stock at the time of the Issuer's initial business combination on a one-for-one basis, subject to certain adjustment described therein and have no expiration date. |
| (2) | On September 24, 2021, Amplitude Healthcare Acquisition Corporation ("AMHC" and the former name of the Issuer) consummated its business combination with Jasper Therapeutics, Inc. (the former name of Jasper Tx Corp.). In connection with the business combination, each share of Class B Common Stock converted to one share of Voting Common Stock. The reporting person resigned as a director and as an officer of the Issuer upon consummation of the business combination. |
| (3) | Pursuant to an agreement by and between the Issuer and Amplitude Healthcare Holdings LLC, concurrent with the consummation of the business combination, these shares of Class B Common Stock were forfeited to the Issuer as of immediately prior to the Merger. |
| (4) | Amplitude Healthcare Holdings LLC, is the record holder of the shares reported herein. Mr. Clifford may be deemed to share beneficial ownership of shares held by Amplitude Healthcare Holdings LLC. Mr. Clifford disclaims beneficial ownership of the shares held by Amplitude Healthcare Holdings LLC except to the extent of his pecuniary interest therein. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Clifford Kenneth F
C/O AMPLITUDE HEALTHCARE HOLDINGS LLC
1177 AVENUE OF THE AMERICAS, FL 40
NEW YORK, NY 10036 |
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| FORMER OFFICER |
Signatures
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| /s/ Bala Venkataraman | | 9/28/2021 |
| **Signature of Reporting Person | Date |
Jasper Therapeutics (NASDAQ:JSPR)
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