0001104659-20-007246.txt : 20200127 0001104659-20-007246.hdr.sgml : 20200127 20200127181906 ACCESSION NUMBER: 0001104659-20-007246 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200123 FILED AS OF DATE: 20200127 DATE AS OF CHANGE: 20200127 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: William H.C. Chang & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006 CENTRAL INDEX KEY: 0001742975 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 20550927 BUSINESS ADDRESS: STREET 1: C/O SEMLER SCIENTIFIC, INC. STREET 2: 911 BERN CT. CITY: SAN JOSE STATE: CA ZIP: 95112 BUSINESS PHONE: (877) 774-4211 MAIL ADDRESS: STREET 1: C/O SEMLER SCIENTIFIC, INC. STREET 2: 911 BERN CT. CITY: SAN JOSE STATE: CA ZIP: 95112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chang William H CENTRAL INDEX KEY: 0001594408 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 20550928 MAIL ADDRESS: STREET 1: C/O SEMLER SCIENTIFIC, INC. STREET 2: 911 BERN COURT, SUITE 110 CITY: SAN JOSE STATE: CA ZIP: 95112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chang Diana Shon CENTRAL INDEX KEY: 0001793712 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 20550929 MAIL ADDRESS: STREET 1: 1301 SHOREWAY RD., SUITE 150 CITY: BELMONT STATE: CA ZIP: 94002 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Semler Scientific, Inc. CENTRAL INDEX KEY: 0001554859 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 261367393 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 911 BERN COURT, SUITE 110 CITY: SAN JOSE STATE: CA ZIP: 95112 BUSINESS PHONE: 408-627-4557 MAIL ADDRESS: STREET 1: 911 BERN COURT, SUITE 110 CITY: SAN JOSE STATE: CA ZIP: 95112 4 1 tm205960d1_form4.xml FORM 4 X0306 4 2020-01-23 0 0001554859 Semler Scientific, Inc. SMLR 0001742975 William H.C. Chang & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006 C/O SEMLER SCIENTIFIC, INC. 911 BERN COURT, SUITE 110. SAN JOSE CA 95112 0 0 1 0 0001594408 Chang William H C/O SEMLER SCIENTIFIC, INC. 911 BERN COURT, SUITE 110. SAN JOSE CA 95112 0 0 1 0 0001793712 Chang Diana Shon C/O SEMLER SCIENTIFIC, INC. 911 BERN COURT, SUITE 110. SAN JOSE CA 95112 0 0 1 0 Common Stock 2020-01-23 4 S 0 1000 50.00 D 392323 D Common Stock 450000 D Common Stock 450000 D Shares are held directly by William H.C. Chang & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006 (the "Trust"). Shares are held in six GRATs, for which Mr. Chang acts as sole Trustee and has voting and investment control. Shares are held in six GRATs, for which Mrs. Chang acts as sole Trustee and has voting and investment control. /s/ William H.C. Chang, Co-Trustee 2020-01-27 /s/ William H.C. Chang 2020-01-27 /s/ Diana Shon Chang 2020-01-27