SEC FORM 3

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Kozlowski Kevin J.

(Last)

(First)

(Middle)

3280 PEACHTREE ROAD, N.E., SUITE 2625

(Street)

ATLANTA

30305

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
10/27/2010

3. Issuer Name and Ticker or Trading Symbol
ExamWorks Group, Inc. [ EXAM ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
	VP & Chief Information Officer

5. 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 Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	45,226	D
Common Stock	70,083	I⁽¹⁾	by ExamWorks Holdings, LLLP

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Employee Stock Option (right to buy)	⁽²⁾	08/07/2018	Common Stock	100,231	$2.8	D
Employee Stock Option (right to buy)	⁽³⁾	08/14/2019	Common Stock	30,846	$3.89	D
Employee Stock Option (right to buy)	⁽⁴⁾	02/15/2020	Common Stock	2,591	$4.86	D
Employee Stock Option (right to buy)	⁽⁵⁾	10/06/2020	Common Stock	51,411	$11.67	D

Explanation of Responses:

1. The reporting person is one of the limited partners of ExamWorks Holdings, LLLP. ExamWorks Holdings, LLLP currently owns 6,728,018 shares of common stock. If ExamWorks Holdings, LLLP distributed such shares of common stock to its limited partners, the reporting person would own 70,083 shares. As a limited partner, the reporting person has no right to participate in the decisions concerning the voting, disposition or conversion of any such securities, and he accordingly disclaims beneficial ownership of the securities held by ExamWorks Holdings, LLLP.

2. Options to purchase 66,819 shares of common stock are currently vested. Options to purchase 33,412 shares of common stock will vest and become exercisable upon the consummation of the Registrant's initial public offering.

3. Options to purchase 10,282 shares of common stock are currently vested. Options to purchase 20,564 shares of common stock will vest and become exercisable upon the consummation of the Registrant's initial public offering.

4. The shares subject to the option vest in three equal annual installments beginning on February 15, 2011.

5. The shares subject to the option vest in three equal annual installments beginning on October 1, 2011.

Remarks:

	/s/ J. Miguel Fernandez de Castro, as Attorney-In-Fact	10/27/2010
	** 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 5 (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.