0001213900-19-024151.txt : 20191119 0001213900-19-024151.hdr.sgml : 20191119 20191119195925 ACCESSION NUMBER: 0001213900-19-024151 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191119 FILED AS OF DATE: 20191119 DATE AS OF CHANGE: 20191119 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: VENKATARAMAN BALAJI CENTRAL INDEX KEY: 0001114916 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39138 FILM NUMBER: 191232764 MAIL ADDRESS: STREET 1: FIRST HORIZON PHARMACEUTICAL CORP STREET 2: 660 HEMBREE PKWY STE 106 CITY: ROSWELL STATE: GA ZIP: 30076 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Amplitude Healthcare Acquisition Corp CENTRAL INDEX KEY: 0001788028 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 842984849 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1177 AVENUE OF THE AMERICAS FL 40 CITY: NEW YORK STATE: NY ZIP: 10036 BUSINESS PHONE: 212- 823-1900 MAIL ADDRESS: STREET 1: 1177 AVENUE OF THE AMERICAS FL 40 CITY: NEW YORK STATE: NY ZIP: 10036 3 1 ownership.xml X0206 3 2019-11-19 0 0001788028 Amplitude Healthcare Acquisition Corp AMHCU 0001114916 VENKATARAMAN BALAJI 1177 AVENUE OF THE AMERICAS, FL 40 NEW YORK NY 10036 1 1 1 0 Chief Executive Officer Class B Common Stock Class A Common Stock 2875000 I See Footnote These shares represent the Class B common stock of the issuer held by Amplitude Healthcare Holdings LLC (the "Sponsor") acquired pursuant to a subscription agreement by and between the Sponsor and the issuer. The Class B common stock owned by the Sponsor includes up to 375,000 shares that are subject to forfeiture in the event the underwriters of the issuer's initial public offering do not exercise in full their over-allotment option as described in the issuer's registration statement. Mr. Venkataraman, the Chief Executive Officer and a director of the issuer, is the manager of Avego Healthcare Capital, LLC, which is a managing member of the Sponsor and shares the voting and dispositive power of the securities held by the Sponsor. Accordingly, each of Mr. Venkataraman and Avego Healthcare Capital, LLC may be deemed to share beneficial ownership of such shares. Each of Mr. Venkataraman and Avego Healthcare Capital, LLC, disclaims any beneficial ownership of the reported shares other than to the extent of any pecuniary interest they may have therein, directly or indirectly. As described in the issuer's registration statement on Form S-1 (File No. 333-234324) under the heading "Description of Securities--Founder Shares", the shares of Class B common stock will automatically convert into shares of Class A common stock at the time of the issuer's initial business combination on a one-for-one basis, subject to certain adjustments described therein and have no expiration date. /s/ Bala Venkataraman 2019-11-19