Annual Statement of Changes in Beneficial Ownership (5)
February 15 2013 - 5:34PM
Edgar (US Regulatory)
FORM 5
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
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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
*
BERNSTEIN RALPH J
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2. Issuer Name
and
Ticker or Trading Symbol
AIR METHODS CORP [AIRM]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
C/O AIR METHODS CORPORATION, 7301 SOUTH PEORIA
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/28/2012
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(Street)
ENGLEWOOD, CO 80112
(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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Amount
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(A) or (D)
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Price
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Common Stock
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12/28/2012
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G
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3000
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D
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$0
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935027
(1)
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D
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Common Stock
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2806881
(2)
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D
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Common Stock
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46500
(3)
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I
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By Spouse
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Common Stock
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135000
(4)
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I
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By The Ralph J. Bernstein Family 2012 Delaware Trust
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Common Stock
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135000
(5)
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I
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By The Yasmeen Bernstein Family 2012 Delaware Trust
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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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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Explanation of Responses:
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(
1)
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These charitable contributions were made prior to the 3-for-1 stock split of Air Methods Corporation which occurred on December 28, 2012.
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(
2)
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The total shares held directly by the reporting person reflect the number of shares held following the 3-for-1 stock split referenced in Footnote 1.
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(
3)
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The total shares held indirectly by the reporting person's spouse reflect the number of shares held following the 3-for-1 stock split referenced in Footnote 1.
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(
4)
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The total shares held indirectly by The Ralph J. Bernstein Family 2012 Delaware Trust reflect the number held following the 3-for-1 stock split referenced in Footnote 1. These shares were previously reported as directly beneficially owned by the reporting person's spouse and indirectly beneficially owned by the reporting person, but were contributed to The Ralph J. Bernstein Family 2012 Delaware Trust on December 27, 2012, of which the reporting person is both settlor and beneficiary.
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(
5)
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The total shares held indirectly by The Yasmeen Bernstein Family 2012 Delaware Trust reflect the number of shares held following the 3-for-1 stock split referenced in Footnoote 1. These shares were previously reported as directly beneficially owned by the reporting person, but were contributed to The Yasmeen Bernstein Family 2012 Delaware Trust on December 27, 2012, of which the reporting person's spouse is both settlor and beneficiary.
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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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BERNSTEIN RALPH J
C/O AIR METHODS CORPORATION
7301 SOUTH PEORIA
ENGLEWOOD, CO 80112
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X
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Signatures
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/s/ Trent J. Carman, Attorney-in-Fact for Ralph J. Bernstein
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2/14/2013
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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 4(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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