1.
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Names of Reporting Persons.
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I.R.S. Identification Nos. of above persons (entities only).
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THOMAS JEFFREY D. |
2.
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Check the Appropriate Box if a Member of a Group (See Instructions)
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a.
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o
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b.
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o
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3.
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SEC Use Only
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4.
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Source of Funds (See Instructions)
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OO
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5.
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Check if Disclosure of Legal Proceedings is Required Pursuant to Items 2(d) or 2(e) o
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6.
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Citizenship or Place of Organization
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United States
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7.
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Sole Voting Power
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983,634 |
8.
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Shared Voting Power
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0 |
9.
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Sole Dispositive Power
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983,634 |
10.
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Shared Dispositive Power
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0 |
11.
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Aggregate Amount Beneficially Owned by Each Reporting Person
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983,634 1 |
(1)
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Excludes 78,276 shares of Common Stock and 145,795 options to purchase Common Stock owned by the Reporting Person’s spouse, Margaret M. Thomas. The Reporting Person disclaims ownership over the Common Stock and options to purchase Common Stock held by the Reporting Person’s spouse, Margaret M. Thomas.
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12.
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Check if the Aggregate Amount in Row 11 Excludes Certain Shares (See Instructions)
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13.
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Percent of Class Represented by Amount in Row 11
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5.54% as of December 20, 2012 |
14.
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Type of Reporting Person (See Instructions)
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IN |
a.
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State the aggregate number and percentage of the class of securities identified pursuant to Item 1 (which may be based on the number of securities outstanding as contained in the most recently available filing with the Commission by the issuer unless the filing person has reason to believe such information is not current) beneficially owned (identifying those shares which there is a right to acquire) by each person named in Item 2. The above mentioned information should also be furnished with respect to persons who, together with any of the persons named in Item 2, comprise a group within the meaning of Section 13(d)(3) of the Act;
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b.
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For each person named in response to paragraph (a), indicate the number of shares as to which there is sole power to vote or to direct the vote, shared power to vote or to direct the vote, sole power to dispose or to direct the disposition, or shared power to dispose or to direct the disposition. Provide the applicable information required by Item 2 with respect to each person with whom the power to vote or to direct the vote or to dispose or direct the disposition is shared;
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c.
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Describe any transactions in the class of securities reported on that were effected during the past sixty days or since the most recent filing of Schedule 13D (§240.13d-191), whichever is less, by the persons named in response to paragraph (a).
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Transaction
Date
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Shares or Units Purchased (Sold)
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Price Per Share
or Unit
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December 20, 2012
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Acquired 31,278 shares of restricted common stock from the Company1
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$0.00
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December 20, 2012
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Acquired 88,750 options to purchase common stock from the Company1
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$0.00
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November 13, 2012
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Forfeiture of 11,980 shares of common stock for payment of taxes2
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$4.47
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1
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See Form 4 Statement of Changes in Beneficial Ownership filed on December 21, 2012 by the Reporting Person.
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2
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See Form 4 Statement of Changes in Beneficial Ownership filed on November 14, 2012 by the Reporting Person.
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d.
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If any other person is known to have the right to receive or the power to direct the receipt of dividends from, or the proceeds from the sale of, such securities, a statement to that effect should be included in response to this item and, if such interest relates to more than five percent of the class, such person should be identified. A listing of the shareholders of an investment company registered under the Investment Company Act of 1940 or the beneficiaries of an employee benefit plan, pension fund or endowment fund is not required.
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Not applicable. |
e.
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If applicable, state the date on which the reporting person ceased to be the beneficial owner of more than five percent of the class of securities.
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Not applicable. |
None. |
January 8, 2013 |
/s/ Jeffrey D. Thomas | |
Jeffrey D. Thomas
Ambassadors Group, Inc.
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President and Chief Executive Officer |