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