0001553350-16-001490.txt : 20160125 0001553350-16-001490.hdr.sgml : 20160125 20160125192625 ACCESSION NUMBER: 0001553350-16-001490 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160119 FILED AS OF DATE: 20160125 DATE AS OF CHANGE: 20160125 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Apollo Medical Holdings, Inc. CENTRAL INDEX KEY: 0001083446 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MANAGEMENT CONSULTING SERVICES [8742] IRS NUMBER: 870042699 STATE OF INCORPORATION: DE FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 450 NORTH BRAND BLVD., STREET 2: SUITE 600 CITY: GLENDALE STATE: CA ZIP: 91203 BUSINESS PHONE: 818-396-8050 MAIL ADDRESS: STREET 1: 700 NORTH BRAND BLVD., STREET 2: SUITE 1400 CITY: GLENDALE STATE: CA ZIP: 91203 FORMER COMPANY: FORMER CONFORMED NAME: SICLONE INDUSTRIES INC DATE OF NAME CHANGE: 19990413 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lam Thomas S. CENTRAL INDEX KEY: 0001664499 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37392 FILM NUMBER: 161359722 MAIL ADDRESS: STREET 1: 1668 GARFIELD AVE., 2ND FLOOR CITY: ALHAMBRA STATE: CA ZIP: 91801 3 1 lam3.xml OWNERSHIP DOCUMENT X0206 3 2016-01-19 0 0001083446 Apollo Medical Holdings, Inc. AMEH 0001664499 Lam Thomas S. 1668 S. GARFIELD AVENUE 2ND FLOOR ALHAMBRA CA 91801 1 0 0 0 Common Stock 2222222 I By Network Medical Management, Inc. Series A Preferred Stock 2015-10-14 Common Stock 1111111 I By Network Medical Management, Inc. Warrants to purchase Common Stock 9.00 2015-10-14 2020-10-14 Common Stock 1111111 I By Network Medical Management, Inc. Reporting Person became a director of the Issuer on January 19, 2016. Represents securities held by Network Medical Management, Inc. ("NMM") prior to Reporting Person becoming a director of the Issuer. The Common Stock beneficially owned by NMM is comprised of (a) 1,111,111 shares of Common Stock that may be acquired upon conversion of Series A Preferred Stock that is currently convertible, and (b) 1,111,111 shares of Common Stock that may be acquired upon exercise of a currently exercisable Warrant. These shares are owned directly by NMM, of which Reporting Person is a director, officer and shareholder. Reporting Person disclaims beneficial ownership of these shares except to 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 any other purpose. The Series A Preferred Stock is convertible into Common Stock, at the option of NMM, at any time after issuance at an initial conversion rate of one-for-one, subject to adjustment in the event of stock dividends, stock splits and certain other similar transactions. The Series A Preferred Stock is mandatorily convertible not sooner than the earlier to occur of (i) the later of (x) January 31, 2017 or (y) 60 days after the date on which the Issuer files its quarterly report on Form 10Q for the period ending September 30, 2016; or (ii) the date on which the Issuer received the written, irrevocable decision of NMM not to require a redemption of the Series A Preferred Stock, in the event that the Issuer engages in one or more transactions resulting in gross proceeds of not less than $5,000,000, not including the proceeds of the transaction with NMM. /s/ Thomas S. Lam, M.D. 2016-01-25