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
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response: 1.0
  
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*
Hanson Jeffrey T

(Last) (First) (Middle)
C/O GRIFFIN-AMERICAN HEALTHCARE REIT
III, INC., 18191 VON KARMAN AVE, STE 300

(Street)
IRVINE CA 92612

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Griffin-American Healthcare REIT III, Inc. [ NONE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CEO & Chairman of the Board
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 55,678(1) D
Common Stock 120,588(1) I By Hanson Family Trust DTD 6/14/2005(2)
Common Stock 22,399 I By April L. Hanson IRA(3)
Common Stock 10,859 I By 401(k) Plan
Common Stock 72,178 I By Defined Benefit Pension Plan(4)
Common Stock 4,278 I By NCT-107, LLC(5)
Common Stock 22,222 I By Griffin-American Healthcare REIT III Advisor, LLC(6)
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. On October 16, 2020, Jeffrey T. Hanson transferred 845 shares of common stock to Hanson Family Trust, DTD 6/14/2005, a trust in which Mr. Hanson serves as a trustee.
2. The reported shares of common stock are held directly by Hanson Family Trust, DTD 6/14/2005, and indirectly by Jeffrey T. Hanson and April L. Hanson, Trustees.
3. The reported shares of common stock are owned by April L. Hanson through her investment retirement account. April L. Hanson is the wife of the reporting person.
4. The reported shares of common stock are held directly in a defined benefit pension plan, of which Mr. Hanson serves as trustee.
5. The reported shares of common stock are owned directly by NCT-107, LLC, a charitable foundation of which Mr. Hanson is the manager. The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for the purposes of Section 16 or for any other purpose.
6. The reported shares of common stock are owned by Griffin-American Healthcare REIT III Advisor, LLC ("GAHRIII Advisor"), which is 75% owned and managed by wholly owned subsidiaries of American Healthcare Investors, LLC ("American Healthcare Investors"). Mr. Hanson serves as a managing director of American Healthcare Investors, and as such, may be deemed to be the beneficial owner of such common stock. Mr. Hanson disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
Remarks:
/s/ JEFFREY T. HANSON 02/12/2021
** 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.