Apollo Medical Holdings, Inc.
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1 SECURITIES & EXCHANGE COMMISSION EDGAR FILING Apollo Medical Holdings, Inc. Form: 4/A Filed: Corporate Issuer CIK: Copyright 2017, Issuer Direct Corporation. All Right Reserved. Distribution of this document is strictly prohibited, subject the terms of use.
2 FORM 4 Check this box if no longer subject Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washingn, D.C STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Comp Act of 1940 OMB APPROVAL OMB Number: Estimated average burden hours per response (Print or Type Responses) 1. Name and Address of Reporting Person * Lam Thomas S. (Last) (First) (Middle) 1668 S. GARFIELD AVENUE, 2ND FLOOR 1.Title of (Street) (City) (State) (Zip) 2. Transaction 2. Issuer Name and Ticker or Trading Symbol Apollo Medical Holdings, Inc. [AMEH] 3. of Earliest Transaction 12/08/ If Amendment, Original Filed 12/12/2017 2A. Deemed Execution, if (Instr. 8) 5. Relationship of Reporting Person(s) Issuer (Check all applicable) X Direcr 10% Owner X Officer (give title below) Other (specify below) Co-Chief Executive Officer 6. Individual or Joint/Group Filing(Check Applicable Line) _X_ Form filed by One Reporting Person Form filed by More than One Reporting Person Table I - Non- Securities Acquired, Disposed of, or Beneficially Owned 3. Transaction V Amount 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) (A) or (D) Price 5. Amount of Securities Beneficially Owned Following Reported Sck (1) 12/08/2017 J 1,664,054 A 1,664,054 I Nature of Indirect Form: Beneficial Direct (D) or Indirect Allied Physicians of California, A Professional Medical Corporation ("Allied") (1) Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Persons who respond the collection of information contained in this form are not required respond unless the form displays a currently valid OMB control number. SEC 1474 (9-02) 1. Title of Sck (1) Sck (1) Sck (1) Sck (1) Transaction Conversion or Exercise Price of 3A. Deemed Execution, if (Instr. 8) Table II - Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 4. Transaction 5. Number of Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) V (A) (D) 6. Exercisable and Expiration Exercisable Expiration 7. Title and Amount of Underlying Securities $ 9 12/08/2017 J 68, /14/ /14/2020 Sck $ 10 12/08/2017 J 34, /30/ /30/2021 Sck $ 10 12/08/2017 J 55, /08/ /08/2022 Sck $ 11 12/08/2017 J 52, /08/ /08/2022 Sck Reporting Owners Title Amount or Number of Shares 8. Price of 9. Number of Securities (Instr. 5) Beneficially Owned Following Reported 10. Form of : Direct (D) or Indirect 68, , I 34, , I 55, , I 52, , I 11. Nature of Indirect Beneficial Reporting Owner Name / Address Relationships Direcr 10% Owner Officer Other
3 Lam Thomas S S. GARFIELD AVENUE 2ND FLOOR X Co-Chief Executive Officer Signatures /s/ Thomas S. Lam, M.D. 12/18/2017 ** Signature of Reporting Person Explanation of Responses: * If the form is filed by more than one reporting person, see Instruction 4(b)(v). ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C and 15 U.S.C. 78ff(a). These shares and warrants are owned directly by Allied Physicians of California, A Professional Medical Corporation ("Allied"), of which Reporting Person is a direcr, officer and shareholder. (1) Reporting Person disclaims beneficial ownership of these shares except the extent of his pecuniary interest therein, and the filing of this report is not an admission that Reporting Person is the beneficial owner of these shares for purposes of Section 16 or for other purpose. On December 8, 2017, a reverse merger transaction between the Issuer and Network Medical Management, Inc. ("NMM") was consummated such that NMM became a wholly-owned subsidiary of the Issuer (the "Merger"). Immediately prior the closing of the Merger (the "Closing"), Allied was a shareholder of NMM. Pursuant the Merger, the shares of NMM common sck previously held by Allied were converted in (i) 1,664,054 shares of common sck of the Issuer, (ii) a warrant 52, shares of common sck of the Issuer at an exercise price of $11.00 per share, (iii) a warrant 55, shares of common sck of the Issuer at an exercise price of $10.00 per share, (iv) cash in lieu of fractional shares, and (v) Allied's pro rata portion, if, of the holdback shares of common sck of the Issuer (such pro rata portion of the holdback shares would, without offset, initially be equal 184, shares of common sck of the Issuer). Immediately prior the Closing, NMM made an in-kind distribution on a pro rata basis its shareholders (including Allied) of the following warrants, which warrants were previously held by NMM: (i) 1,111,111 Series A warrants (of which Allied will receive 68, Series A warrants) common sck of the Issuer, exercisable at time prior Ocber 14, 2020 at an exercise price of $9.00 per share, and (ii) 555,555 Series B warrants (of which Allied will receive 34, Series B warrants) common sck of the Issuer, exercisable at time prior March 30, 2021 at an exercise price of $10.00 per share. Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. Potential persons who are respond the collection of information contained in this form are not required respond unless the form displays a currently valid OMB number.
4 FORM 4 Check this box if no longer subject Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washingn, D.C STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Comp Act of 1940 OMB APPROVAL OMB Number: Estimated average burden hours per response (Print or Type Responses) 1. Name and Address of Reporting Person * Lam Thomas S. (Last) (First) (Middle) 1668 S. GARFIELD AVENUE, 2ND FLOOR 1.Title of (Street) (City) (State) (Zip) 2. Transaction 2. Issuer Name and Ticker or Trading Symbol Apollo Medical Holdings, Inc. [AMEH] 3. of Earliest Transaction 12/08/ If Amendment, Original Filed 12/12/2017 2A. Deemed Execution, if (Instr. 8) 5. Relationship of Reporting Person(s) Issuer (Check all applicable) X Direcr 10% Owner X Officer (give title below) Other (specify below) Co-Chief Executive Officer 6. Individual or Joint/Group Filing(Check Applicable Line) _X_ Form filed by One Reporting Person Form filed by More than One Reporting Person Table I - Non- Securities Acquired, Disposed of, or Beneficially Owned 3. Transaction V Amount 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) (A) or (D) Price 5. Amount of Securities Beneficially Owned Following Reported Sck (1) 12/08/2017 J 1,664,054 A 1,664,054 I Nature of Indirect Form: Beneficial Direct (D) or Indirect Allied Physicians of California, A Professional Medical Corporation ("Allied") (1) Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Persons who respond the collection of information contained in this form are not required respond unless the form displays a currently valid OMB control number. SEC 1474 (9-02) 1. Title of Sck (1) Sck (1) Sck (1) Sck (1) Transaction Conversion or Exercise Price of 3A. Deemed Execution, if (Instr. 8) Table II - Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 4. Transaction 5. Number of Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) V (A) (D) 6. Exercisable and Expiration Exercisable Expiration 7. Title and Amount of Underlying Securities $ 9 12/08/2017 J 68, /14/ /14/2020 Sck $ 10 12/08/2017 J 34, /30/ /30/2021 Sck $ 10 12/08/2017 J 55, /08/ /08/2022 Sck $ 11 12/08/2017 J 52, /08/ /08/2022 Sck Reporting Owners Title Amount or Number of Shares 8. Price of 9. Number of Securities (Instr. 5) Beneficially Owned Following Reported 10. Form of : Direct (D) or Indirect 68, , I 34, , I 55, , I 52, , I 11. Nature of Indirect Beneficial Reporting Owner Name / Address Relationships Direcr 10% Owner Officer Other
5 Lam Thomas S S. GARFIELD AVENUE 2ND FLOOR X Co-Chief Executive Officer Signatures /s/ Thomas S. Lam, M.D. 12/18/2017 ** Signature of Reporting Person Explanation of Responses: * If the form is filed by more than one reporting person, see Instruction 4(b)(v). ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C and 15 U.S.C. 78ff(a). These shares and warrants are owned directly by Allied Physicians of California, A Professional Medical Corporation ("Allied"), of which Reporting Person is a direcr, officer and shareholder. (1) Reporting Person disclaims beneficial ownership of these shares except the extent of his pecuniary interest therein, and the filing of this report is not an admission that Reporting Person is the beneficial owner of these shares for purposes of Section 16 or for other purpose. On December 8, 2017, a reverse merger transaction between the Issuer and Network Medical Management, Inc. ("NMM") was consummated such that NMM became a wholly-owned subsidiary of the Issuer (the "Merger"). Immediately prior the closing of the Merger (the "Closing"), Allied was a shareholder of NMM. Pursuant the Merger, the shares of NMM common sck previously held by Allied were converted in (i) 1,664,054 shares of common sck of the Issuer, (ii) a warrant 52, shares of common sck of the Issuer at an exercise price of $11.00 per share, (iii) a warrant 55, shares of common sck of the Issuer at an exercise price of $10.00 per share, (iv) cash in lieu of fractional shares, and (v) Allied's pro rata portion, if, of the holdback shares of common sck of the Issuer (such pro rata portion of the holdback shares would, without offset, initially be equal 184, shares of common sck of the Issuer). Immediately prior the Closing, NMM made an in-kind distribution on a pro rata basis its shareholders (including Allied) of the following warrants, which warrants were previously held by NMM: (i) 1,111,111 Series A warrants (of which Allied will receive 68, Series A warrants) common sck of the Issuer, exercisable at time prior Ocber 14, 2020 at an exercise price of $9.00 per share, and (ii) 555,555 Series B warrants (of which Allied will receive 34, Series B warrants) common sck of the Issuer, exercisable at time prior March 30, 2021 at an exercise price of $10.00 per share. Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. Potential persons who are respond the collection of information contained in this form are not required respond unless the form displays a currently valid OMB number.
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