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*
Davies Thomas

(Last) (First) (Middle)
C/O AKUMIN INC.
8300 W. SUNRISE BOULEVARD

(Street)
PLANTATION FL 33322

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/01/2022
3. Issuer Name and Ticker or Trading Symbol
AKUMIN INC. [ AKU ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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 16,829 D
Common Stock(1) 21,008 D
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
Stock Option (right to buy) (2) 03/15/2026 Common Stock 150,000 $0.5 D
Stock Option (right to buy) (3) 11/16/2025 Common Stock 50,000 $3.74 D
Stock Option (right to buy) (4) 11/18/2026 Common Stock 52,213 $3.29 D
Explanation of Responses:
1. The Reporting Person was granted 21,008 Restricted Share Units on March 9, 2021 under the Company's Amended and Restated Restricted Share Unit Plan. Fifty percent of the Restricted Share Units will vest on March 9, 2022. The remaining 50% will vest on March 9, 2023.
2. The Reporting Person was granted 150,000 Stock Options on March 15, 2016 under the Company's Amended and Restated Stock Option Plan (the "Option Plan"). One-hundred percent of the Stock Options have vested.
3. The Reporting Person was granted 50,000 Stock Options on November 16, 2018 under the Option Plan. One-hundred percent of the Stock Options have vested.
4. The Reporting Person was granted 52,213 Stock Options on November 18, 2019 under the Option Plan. Sixty-seven percent of the Stock Options have vested. The remaining 33% will vest on November 18, 2022.
Remarks:
Exhibit List - Exhibit 24 - Power of Attorney
/s/ Thomas P. Conaghan as attorney-in-fact for Thomas Davies 01/03/2022
** 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.