Statement of Changes in Beneficial Ownership (4)
May 21 2021 - 9:17AM
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
*
Ervin Jeffrey S |
2. Issuer Name and Ticker or Trading Symbol
IMAC Holdings, Inc.
[
IMAC
]
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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) Chief Executive Officer |
(Last)
(First)
(Middle)
C/O IMAC HOLDINGS, INC., 1605 WESTGATE CIRCLE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/21/2021 |
(Street)
BRENTWOOD, TN 37027
(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 | 5/21/2021 | | M | | 37500 | A | (1) | 333900 | D | |
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 |
Time-Based Restricted Stock Units (1) | (1) | 5/21/2021 | | M | | | 37500 | (1) | (1) | Common Stock | 37500 | $0 | 75000 | D | |
Explanation of Responses: |
(1) | Represents time-based restricted stock units ("RSUs") awarded by the Issuer on May 21, 2019, and vest over a period of four years in four equal annual installments, with 37,500 shares vesting on each of May 21, 2020, May 21, 2021, May 21, 2022 and May 21, 2023, and with full acceleration of vesting upon a change of control of the Issuer, in accordance with the terms of the Issuer's 2019 Incentive Compensation Plan and the form of restricted stock unit agreement with respect to such award. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Ervin Jeffrey S C/O IMAC HOLDINGS, INC. 1605 WESTGATE CIRCLE BRENTWOOD, TN 37027 | X |
| Chief Executive Officer |
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Signatures
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/s/ Jeffrey S. Ervin | | 5/21/2021 |
**Signature of Reporting Person | Date |
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