SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
  
Form 3 Holdings Reported.
  
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
HAQ MAHMUD UL

(Last) (First) (Middle)
7 CLYDE ROAD

(Street)
SOMERSET NJ 08873

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MTBC, Inc. [ MTBC ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Executive Chairman
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2020
4. If Amendment, Date of Original Filed (Month/Day/Year)
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-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (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 11/23/2020 G(1) 1,250,000 D $0 4,585,820 D
Common Stock 11/23/2020 G(1) 1,250,000 A $0 47,000 I By spouse
Common stock 12/14/2020 G(2) 1,128,000 D $0 4,585,820 D
Common stock 12/14/2020 G(2) 1,128,000 A $0 1,203,000 I See footnote(3)
Common stock 12/14/2020 G(4) 1,128,000 D $0 47,000 I By spouse
Common stock 12/14/2020 G(4) 1,128,000 A $0 1,203,000 I See footnote(5)
Common stock 12/15/2020 G(6) 75,000 D $0 4,585,820 D
Common stock 12/15/2020 G(6) 75,000 A $0 1,203,000 I See footnote(7)
Common stock 12/15/2020 G(8) 75,000 D $0 47,000 I By spouse
Common stock 12/15/2020 G(8) 75,000 A $0 1,203,000 I See footnote(9)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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. Represents a gift of securities by the reporting person to the reporting person's spouse. This is not an open market sale of securities.
2. Represents a gift of securities by the reporting person to a trust where the reporting person's spouse is the beneficiary. This is not an open market sale of securities.
3. Shares are owned by a trust where the reporting person's spouse is the beneficiary.
4. Represents a gift of securities by the reporting person's spouse to a trust where the reporting person is the beneficiary. This is not an open market sale of securities.
5. Shares are owned by a trust where the reporting person is the beneficiary.
6. Represents a gift of securities by the reporting person to a trust where the reporting person's spouse is the beneficiary. This is not an open market sale of securities.
7. Shares are owned by a trust where the reporting person's spouse is the beneficiary.
8. Represents a gift of securities by the reporting person's spouse to a trust where the reporting person is the beneficiary. This is not an open market sale of securities.
9. Shares are owned by a trust where the reporting person is the beneficiary.
/s/ Norman Roth, Attorney-in-Fact for Mahmud Ul Haq 01/08/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.