SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Hanson Jeffrey T

(Last) (First) (Middle)
C/O GRIFFIN-AMERICAN HEALTHCARE REIT IV,
INC., 18191 VON KARMAN AVE., STE. 300

(Street)
IRVINE CA 92612

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Griffin-American Healthcare REIT IV, Inc. [ NONE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CEO & Chairman of the Board
3. Date of Earliest Transaction (Month/Day/Year)
10/05/2018
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Class I Common Stock 10/05/2018 P 1,215(1) A $9.65 56,084 I By Jeffrey T Hanson and April L Hanson Family Rev Trust DTD 06/14/2005(2)
Class T Common Stock 2,188 D
Class T Common Stock 20,206 I By Jeffrey T Hanson and April L Hanson Family Rev Trust DTD 06/14/2005(3)
Class T Common Stock 1,458 I By April Hanson IRA(4)
Class T Common Stock 2,917 I By Crescentridge Inc 401K Plan(5)
Class T Common Stock 19,479 I By JTH Holdings LLC DBPP(6)
Class T Common Stock 20,833 I By Griffin-American Healthcare REIT IV Advisor, LLC(7)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. The reported shares of Class I common stock were acquired at $9.65 per share by Mr. Hanson pursuant to an Executive Stock Purchase Plan between Mr. Hanson and the Issuer, entered into on 12/31/2017
2. The reported shares of Class I common stock are held directly by Jeffrey T Hanson and April L Hanson Family Rev Trust DTD 06/14/2005, and indirectly by Mr. Hanson and April L Hanson, Trustees.
3. The reported shares of Class T common stock are held directly by Jeffrey T Hanson and April L Hanson Family Rev Trust DTD 06/14/2005, and indirectly by Mr. Hanson and April L Hanson, Trustees.
4. The reported shares of Class T common stock are owned by April Hanson through her investment retirement account. April Hanson is the wife of the reporting person.
5. The reported shares of Class T common stock are owned by Mr. Hanson through his 401(k) plan.
6. The reported shares of Class T common stock are held directly in a defined benefit pension plan, of which Mr. Hanson serves as Trustee.
7. The reported shares of Class T common stock are owned by Griffin-American Healthcare REIT IV Advisor, LLC ("GAHRIV Advisor"). Mr. Hanson serves as a managing director of American Healthcare Investors, LLC, the managing member of GAHRIV Advisor, and as such, may be deemed to be the beneficial owner of such common stock. Mr. Hanson disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
Remarks:
/s/ JEFFREY T. HANSON 10/09/2018
** 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 4 (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.