0001640173-21-000002.txt : 20211001
0001640173-21-000002.hdr.sgml : 20211001
20211001205609
ACCESSION NUMBER: 0001640173-21-000002
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211001
FILED AS OF DATE: 20211001
DATE AS OF CHANGE: 20211001
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Sanders J. Grayson
CENTRAL INDEX KEY: 0001640173
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-55434
FILM NUMBER: 211300720
MAIL ADDRESS:
STREET 1: 27 LA QUINTA
CITY: IRVINE
STATE: CA
ZIP: 92612
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Griffin-American Healthcare REIT III, Inc.
CENTRAL INDEX KEY: 0001566912
STANDARD INDUSTRIAL CLASSIFICATION: REAL ESTATE INVESTMENT TRUSTS [6798]
IRS NUMBER: 461749436
STATE OF INCORPORATION: MD
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 18191 VON KARMAN AVENUE
STREET 2: SUITE 300
CITY: IRVINE
STATE: CA
ZIP: 92612
BUSINESS PHONE: 949-270-9200
MAIL ADDRESS:
STREET 1: 18191 VON KARMAN AVENUE
STREET 2: SUITE 300
CITY: IRVINE
STATE: CA
ZIP: 92612
4
1
wf-form4_163313614966362.xml
FORM 4
X0306
4
2021-10-01
1
0001566912
Griffin-American Healthcare REIT III, Inc.
NONE
0001640173
Sanders J. Grayson
C/O GRIFFIN-AMERICAN HEALTHCARE REIT
III, INC. 18191 VON KARMAN AVE, STE. 300
IRVINE
CA
92612
1
0
0
0
Common Stock
2021-10-01
4
D
0
18342
D
0
D
Common Stock
2021-10-01
4
D
0
27000
D
0
I
By Sanders Living Trust DTD 1/25/2017
Reflects the disposition of shares of the Issuer's common stock in connection with the merger (the "Merger") of the Issuer with and into Continental Merger Sub, LLC, a wholly-owned subsidiary of American Healthcare REIT, Inc. ("AHR"). In the Merger, each share of the Issuer's common stock, par value $0.01 per share, was converted into the right to receive 0.9266 shares of AHR Class I common stock, par value $0.01 per share ("AHR Class I Common Stock"). There is no established market for shares of AHR Class I Common Stock. On March 18, 2021, the board of directors of AHR approved an estimated value per share of AHR Class I Common Stock of $9.22.
The reported shares of common stock are held directly by Sanders Living Trust, DTD 1/25/2017, and indirectly by J. Grayson Sanders and Marylee Sanders, Trustees.
/s/ J. GRAYSON SANDERS
2021-10-01