0001104659-21-024373.txt : 20210216 0001104659-21-024373.hdr.sgml : 20210216 20210216171226 ACCESSION NUMBER: 0001104659-21-024373 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201231 FILED AS OF DATE: 20210216 DATE AS OF CHANGE: 20210216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chang Diana Shon CENTRAL INDEX KEY: 0001793712 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 21640767 MAIL ADDRESS: STREET 1: 1301 SHOREWAY RD., SUITE 150 CITY: BELMONT STATE: CA ZIP: 94002 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chang William H CENTRAL INDEX KEY: 0001594408 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 21640768 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: 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: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 21640769 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 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: 2340-2348 WALSH AVENUE, SUITE 2344 CITY: SANTA CLARA STATE: CA ZIP: 95051 BUSINESS PHONE: 408-627-4557 MAIL ADDRESS: STREET 1: 2340-2348 WALSH AVENUE, SUITE 2344 CITY: SANTA CLARA STATE: CA ZIP: 95051 5 1 tm216980-1_5seq1.xml OWNERSHIP DOCUMENT X0306 5 2020-12-31 0 0 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. 2340-2348 WALSH AVENUE, SUITE 2344 SANTA CLARA CA 95051 0 0 1 0 0001594408 Chang William H C/O SEMLER SCIENTIFIC, INC. 2340-2348 WALSH AVENUE, SUITE 2344 SANTA CLARA CA 95051 0 0 1 0 0001793712 Chang Diana Shon C/O SEMLER SCIENTIFIC, INC. 2340-2348 WALSH AVENUE, SUITE 2344 SANTA CLARA CA 95051 0 0 1 0 Common Stock 2020-09-03 5 G 0 70101 0 D 379899 D Common Stock 2020-09-03 5 G 0 70101 0 D 379899 D Common Stock 2020-09-03 5 G 0 140202 0 A 532525 D Common Stock 2020-10-09 5 G 0 29523 0 D 350376 D Common Stock 2020-10-09 5 G 0 29523 0 D 350376 D Common Stock 2020-10-09 5 G 0 59046 0 A 591571 D Common Stock 2020-12-04 5 G 0 171618 0 D 419953 D Common Stock 2020-12-09 5 G 0 2416 0 D 417537 D Common Stock 2020-12-09 5 G 0 2416 0 A 2416 I By Limited Liability Company 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. Shares are held directly by William H.C. Chang & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006. Shares are held by Chang 2020 GP LLC, for which Mr. and Mrs. Chang are the sole managers and share voting and investment control. /s/ William H.C. Chang, Co-Trustee 2021-02-16 /s/ William H.C. Chang 2021-02-16 /s/ Diana Shon Chang 2021-02-16