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
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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*
Carlucci Joseph A

(Last) (First) (Middle)
C/O ARAH INC.
500 CUMMINGS CENTER, SUITE 6550

(Street)
BEVERLY MA 01915

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
American Renal Associates Holdings, Inc. [ ARA ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
3. Date of Earliest Transaction (Month/Day/Year)
06/09/2020
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
Common Stock 06/09/2020 M(1) 208,360 A $1.28 454,344 D
Common Stock 06/09/2020 M(1) 208,360 A $1.28 662,704 D
Common Stock 06/09/2020 F(2) 71,825 D $6.78 590,879 D
Common Stock 654,285 I See Footnote(3)
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
Stock Option (Right to Buy) $1.28 06/09/2020 M 208,360 (4) 07/09/2020 Common Stock 208,360 $0 0 D
Stock Option (Right to Buy) $1.28 06/09/2020 M 208,360 (5) 07/09/2020 Common Stock 208,360 $0 0 D
Explanation of Responses:
1. Reflects the exercise of options that were otherwise set to expire on July 9, 2020.
2. Reflects shares withheld by the issuer to cover a portion of the option exercise price and tax withholding obligations in connection with the exercise of an expiring stock option.
3. Shares held by trusts for the benefit of the Reporting Person's family. The Reporting Person disclaims beneficial ownership of the shares held by such trusts, except to the extent of his pecuniary interest therein. The filing of this statement by the Reporting Person shall not be deemed an admission that, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, such Reporting Person is the beneficial owner of the securities reported herein.
4. An option that vested upon the attainment by Centerbridge Capital Partners, L.P. and certain of its affiliates (together, "Centerbridge") of both a 2.5 times return on investment ("MOIC") and a 20% internal rate of return ("IRR").
5. An option that vested upon the attainment by Centerbridge of both a 3.0 times MOIC and a 25% IRR.
Remarks:
/s/ Victoria A. Labriola, by power of attorney 06/11/2020
** 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 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.