Annual Statement of Changes in Beneficial Ownership (5)
February 12 2021 - 2:55PM
Edgar (US Regulatory)
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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
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL 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
*
Hanson Jeffrey T | 2. Issuer Name and Ticker or Trading SymbolGriffin-American Healthcare REIT III, Inc. [NONE] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) CEO & Chairman of the Board |
(Last)
(First)
(Middle)
C/O GRIFFIN-AMERICAN HEALTHCARE REIT, III, INC., 18191 VON KARMAN AVE, STE 300 | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2020 |
(Street)
IRVINE, CA 92612
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 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) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Amount | (A) or (D) | Price |
Common Stock | | | | | | | 55678 (1) | D | |
Common Stock | | | | | | | 120588 (1) | I | By Hanson Family Trust DTD 6/14/2005 (2) |
Common Stock | | | | | | | 22399 | I | By April L. Hanson IRA (3) |
Common Stock | | | | | | | 10859 | I | By 401(k) Plan |
Common Stock | | | | | | | 72178 | I | By Defined Benefit Pension Plan (4) |
Common Stock | | | | | | | 4278 | I | By NCT-107, LLC (5) |
Common Stock | | | | | | | 22222 | I | By Griffin-American Healthcare REIT III Advisor, LLC (6) |
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) | 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 (MM/DD/YYYY) | 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 at End of Issuer's Fiscal Year (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | On October 16, 2020, Jeffrey T. Hanson transferred 845 shares of common stock to Hanson Family Trust, DTD 6/14/2005, a trust in which Mr. Hanson serves as a trustee. |
(2) | The reported shares of common stock are held directly by Hanson Family Trust, DTD 6/14/2005, and indirectly by Jeffrey T. Hanson and April L. Hanson, Trustees. |
(3) | The reported shares of common stock are owned by April L. Hanson through her investment retirement account. April L. Hanson is the wife of the reporting person. |
(4) | The reported shares of common stock are held directly in a defined benefit pension plan, of which Mr. Hanson serves as trustee. |
(5) | The reported shares of common stock are owned directly by NCT-107, LLC, a charitable foundation of which Mr. Hanson is the manager. The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for the purposes of Section 16 or for any other purpose. |
(6) | The reported shares of common stock are owned by Griffin-American Healthcare REIT III Advisor, LLC ("GAHRIII Advisor"), which is 75% owned and managed by wholly owned subsidiaries of American Healthcare Investors, LLC ("American Healthcare Investors"). Mr. Hanson serves as a managing director of American Healthcare Investors, and as such, may be deemed to be the beneficial owner of such common stock. Mr. Hanson disclaims beneficial ownership of the reported securities 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 |
Hanson Jeffrey T C/O GRIFFIN-AMERICAN HEALTHCARE REIT III, INC., 18191 VON KARMAN AVE, STE 300 IRVINE, CA 92612 | X |
| CEO & Chairman of the Board |
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Signatures
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/s/ JEFFREY T. HANSON | | 2/12/2021 |
**Signature of Reporting Person | Date |
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