Statement of Changes in Beneficial Ownership (4)
January 02 2018 - 5:26PM
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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
NIHALANI SURESH
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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)
_____ Director
_____ 10% Owner
_____ Officer (give title below)
__
X
__ Other (specify below)
Former Director
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(Last)
(First)
(Middle)
7352 ZAHARIAS CT
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3. Date of Earliest Transaction
(MM/DD/YYYY)
12/8/2017
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(Street)
MOORPARK, CA 93021
(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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Common Stock, par value $0.001 per share
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39998
(1)
(2)
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D
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Common Stock, par value $0.001 per share
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40000
(1)
(2)
(3)
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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. 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
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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 Following Reported Transaction(s) (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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Code
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V
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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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Stock Option (right to buy)
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$5
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10/14/2016
(4)
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9/14/2026
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Common Stock, par value $0.001 per share
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20000
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40000
(1)
(6)
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D
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Stock Option (right to buy)
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$5.79
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3/15/2016
(5)
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2/14/2026
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Common Stock, par value $0.001 per share
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20000
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40000
(1)
(6)
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D
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Explanation of Responses:
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(1)
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This form is not filed to reflect any transactions but to disclose that Reporting Person resigned from the board of directors of Apollo Medical Holdings, Inc. ("ApolloMed"), effective as of the closing of a merger between Apollo Acquisition Corp., a wholly owned subsidiary of ApolloMed, and Network Medical Management, Inc., a California corporation, on December 8, 2017, and as a result, is no longer subject to Section 16, Form 4 or Form 5 obligations based on his directorship at ApolloMed.
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(2)
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As of December 8, 2017, Reporting Person had direct ownership of 39,998 79,998 shares of common stock of ApolloMed.
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(3)
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Such 40,000 shares of common stock of ApolloMed are no longer held by The Shining Star Trust, a trust of which Reporting Person is a beneficiary and trustee, and are held by Reporting Person directly.
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(4)
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The option vested at the rate of one-twelfth of the shares per month commencing on October 14, 2016.
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(5)
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The option vested at the rate of one-twelfth of the shares per month commencing on March 15, 2016.
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(6)
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As of December 8, 2017, Reporting Person had direct ownership of stock options with respect to 40,000 shares of common stock of ApolloMed.
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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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NIHALANI SURESH
7352 ZAHARIAS CT
MOORPARK, CA 93021
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Former Director
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Signatures
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/s/ Suresh Nihalani
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1/2/2018
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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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