Initial Statement of Beneficial Ownership (3)
August 05 2019 - 2:34PM
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
Estimated average burden
hours per response...
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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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GARVIS WILLIAM GEORGE
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2. Date of Event Requiring Statement (MM/DD/YYYY)
8/1/2019
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3. Issuer Name
and
Ticker or Trading Symbol
STREAMLINE HEALTH SOLUTIONS INC. [STRM]
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(Last)
(First)
(Middle)
1175 PEACHTREE STREET NE, 10TH FLOOR
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
SVP & COO /
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(Street)
ATLANTA, GA 30361
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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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)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock, $.01 par value
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50000
(1)
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D
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Common Stock, $.01 par value
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100000
(2)
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D
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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)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option (right to buy)
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(3)
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5/22/2026
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Common Stock, $0.01 Par Value
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50000
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$1.19
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D
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Stock Option (right to buy)
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(4)
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3/2/2027
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Common Stock, $0.01 Par Value
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25000
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$1.18
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D
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Explanation of Responses:
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(1)
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Represents an award of Restricted Stock granted outside the Streamline Health Solutions, Inc. Second Amended and Restated 2013 Stock Incentive Plan to the Reporting Person on August 1, 2019, which vests, assuming continued employment, in four substantially equal installments on November 1, 2019, February 1, 2020, May 1, 2020 and August 1, 2020.
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(2)
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Represents an award of Restricted Stock, which vests, assuming continued employment, in three substantially equal installments: 33% on January 29, 2020, 33% January 29, 2021, and 34% January 29, 2022.
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(3)
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The stock options shall vest and become exercisable in three substantially equal annual installments commencing on May 23, 2017, subject to the provisions in the agreement relating to the effect of termination of employment.
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(4)
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The stock options shall vest and become exercisable in thirty-six substantially equal monthly installments commencing on April 2, 2017, subject to the provisions in the agreement relating to the effect of termination of employment.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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GARVIS WILLIAM GEORGE
1175 PEACHTREE STREET NE, 10TH FLOOR
ATLANTA, GA 30361
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SVP & COO
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Signatures
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/s/ Thomas Gibson, as attorney-in-fact
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8/2/2019
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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