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*
Sim Brandon

(Last) (First) (Middle)
1668 S. GARFIELD AVENUE
2ND FLOOR

(Street)
ALHAMBRA CA 91801

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/26/2020
3. Issuer Name and Ticker or Trading Symbol
Apollo Medical Holdings, Inc. [ AMEH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Interim Co-COO
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 36,663(1)(2) D
Common Stock 2,000 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
Explanation of Responses:
1. The issuer previously granted 44,589 shares of restricted stock to the reporting person pursuant to the Apollo Medical Holdings, Inc. 2015 Equity Incentive Plan, under which 22,285 shares vested on May 31, 2020 and 22,284 shares shall vest on May 31, 2021, and which grant is accompanied by a tax-offset right entitling the reporting person to receive, upon vesting, a cash payment equal to the tax withholding incurred upon the vesting of shares.
2. Represents the grant of 44,589 shares of restricted stock, less 7,906 shares surrendered to offset against withholding tax liability incurred in connection with vesting of shares on May 31, 2020.
/s/ Brandon Sim 06/03/2020
** 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.