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*
Costa Michael Lourenco

(Last) (First) (Middle)
C/O SABRA HEALTH CARE REIT, INC.
18500 VON KARMAN AVENUE, SUITE 550

(Street)
IRVINE CA 92612

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/11/2021
3. Issuer Name and Ticker or Trading Symbol
Sabra Health Care REIT, Inc. [ SBRA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Executive VP & CAO
5. If Amendment, Date of Original Filed (Month/Day/Year)
01/13/2021
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 96,641(1)(2) D
Common Stock 784 I By Reporting Person's IRA
Common Stock 208 I By Reporting Person's Spouse's IRA
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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. This amendment to Form 3 corrects the number of securities beneficially owned directly by the reporting person, as reported in the original Form 3. Two subsequent Form 4 filings (filed on January 15, 2021 and March 2, 2021) did not reflect the correct number of shares beneficially owned directly by the reporting person. As of the date of this report and after giving effect to the subsequent Form 4 filings, the reporting person beneficially owns directly 100,699 shares of the Issuer's Common Stock.
2. Includes 18,140 stock units that, upon settlement, will be paid on a one-for-one basis in shares of the Issuer's Common Stock.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Harold W. Andrews, Jr. as Attorney-in-Fact 04/29/2021
** 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 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.