0001250853-22-000121.txt : 20221212 0001250853-22-000121.hdr.sgml : 20221212 20221212185053 ACCESSION NUMBER: 0001250853-22-000121 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221208 FILED AS OF DATE: 20221212 DATE AS OF CHANGE: 20221212 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Sim Kenneth T. CENTRAL INDEX KEY: 0001725499 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37392 FILM NUMBER: 221458223 MAIL ADDRESS: STREET 1: 1668 S. GARFIELD AVE. STREET 2: 2ND FLOOR CITY: ALHAMBRA STATE: CA ZIP: 91801 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Apollo Medical Holdings, Inc. CENTRAL INDEX KEY: 0001083446 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MANAGEMENT CONSULTING SERVICES [8742] IRS NUMBER: 870042699 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1668 S. GARFIELD AVENUE STREET 2: 2ND FLOOR CITY: ALHAMBRA STATE: CA ZIP: 91801 BUSINESS PHONE: (626) 282-0288 MAIL ADDRESS: STREET 1: 1668 S. GARFIELD AVENUE STREET 2: 2ND FLOOR CITY: ALHAMBRA STATE: CA ZIP: 91801 FORMER COMPANY: FORMER CONFORMED NAME: SICLONE INDUSTRIES INC DATE OF NAME CHANGE: 19990413 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2022-12-08 0 0001083446 Apollo Medical Holdings, Inc. AMEH 0001725499 Sim Kenneth T. 1668 S. GARFIELD AVE. 2ND FLOOR ALHAMBRA CA 91801 1 1 0 0 Executive Chairman Common Stock 2022-12-08 4 M 0 51445 10 A 243272 D Common Stock 2022-12-08 4 M 0 48587 11 A 291859 D Common Stock 42996 I By Kenneth T. Sim Pension Plan Trust Common Stock 230688 I By grantor retained annuity trust Common Stock 520117 I By Kenneth T & Simone S Sim Family Trust Common Stock 10299259 I By Allied Physicians of California, A Professional Medical Corporation Warrants to purchase Common Stock 10 2022-12-08 4 M 0 51445.18 D 2017-12-08 2022-12-08 Common Stock 51445.18 0 D Warrants to purchase Common Stock 11 2022-12-08 4 M 0 48587.12 D 2017-12-08 2022-12-08 Common Stock 48587.12 0 D These securities are held by the Kenneth T. Sim Pension Plan Trust U.A. dated 12/18/2007. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the filing of this report is not an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose. These securities are held by a grantor retained annuity trust for the benefit of the Reporting Person and his children. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. These securities are held by the Kenneth T & Simone S Sim Family Trust U/A dated 11/07/2013. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the filing of this report is not an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose. These securities are beneficially owned by Allied Physicians of California, A Profession Medical Corporation, of which the Reporting Person is a director, officer and shareholder. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the filing of this report is not an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose. On December 8, 2017, a reverse merger transaction between the Issuer and Network Medical Management, Inc. ("NMM") was consummated such that NMM became a wholly-owned subsidiary of the Issuer (the "Merger). Immediately prior to the closing of the Merger, the Reporting Person was a shareholder of NMM. Pursuant to the Merger, the shares of NMM common stock previously held by Reporting Person were converted into (i) 1,563,804 shares of common stock of the Issuer, (ii) a warrant to purchase 48,587.12 shares of common stock of the Issuer at an exercise price of $11.00 per share, (iii) a warrant to purchase 51,445.18 shares of common stock of the Issuer at an exercise price of $10.00 per share, (iv) cash in lieu of fractional shares, and (v) the Reporting Person's pro rata portion, if any, of the holdback shares of common stock of the Issuer (such pro rata portion of the holdback shares would, without offset, initially be equal to 173,756.04 shares of common stock of the Issuer). /s/ Kenneth T. Sim 2022-12-12