4 1 file001.txt FORM 4 FORM 4 [ ] CHECK THIS BOX IF NO LONGER SUBJECT TO SECTION 16. FORM 4 OR FORM 5 OBLIGATIONS MAY CONTINUE. SEE INSTRUCTION 1(B). 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, SECTION 17(a) OF THE PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 OR SECTION 30(f) OF THE INVESTMENT COMPANY ACT OF 1940 ------------------------------------------------------------------------------- 1. NAME AND ADDRESS OF REPORTING PERSON* Eames, Sarah L. ----------------------------------------------------- (LAST) (FIRST) (MIDDLE) Allied Healthcare International Inc. 555 Madison Avenue, 30th Floor ----------------------------------------------------- (STREET) New York, New York 10022 ----------------------------------------------------- (CITY) (STATE) (ZIP) ------------------------------------------------------------------------------- 2. ISSUER NAME AND TICKER OR TRADING SYMBOL Allied Healthcare International Inc. ------------------------------------------------------------------------------- 3. IRS OR SOCIAL SECURITY NUMBER OF REPORTING PERSON (VOLUNTARY) ------------------------------------------------------------------------------- 4. STATEMENT FOR MONTH/YEAR July 2002 ------------------------------------------------------------------------------- 5. IF AMENDMENT, DATE OF ORIGINAL (MONTH/YEAR) ------------------------------------------------------------------------------- 6. RELATIONSHIP OF REPORTING PERSON(S) TO ISSUER (CHECK ALL APPLICABLE) [X] DIRECTOR [ ] 10% OWNER [X] OFFICER (GIVE TITLE BELOW) [ ] OTHER (SPECIFY BELOW) President and Chief Operating Officer -------------------------------------------------- ------------------------------------------------------------------------------- 7. 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 --------------------------------------------------------------------------------------------------------------------------------- 5. AMOUNT OF 6. OWNER- SECURITIES SHIP 2. TRANS- 3. TRANS- 4. SECURITIES ACQUIRED (A) BENEFICIALLY FORM: ACTION ACTION OR DISPOSED OF (D) OWNED AT DIRECT 7. NATURE OF DATE CODE (INSTR. 3, 4 AND 5) END OF (D) OR INDIRECT 1. TITLE OF SECURITY (MONTH/ (INSTR. 8) -------------------------- MONTH INDIRECT BENEFICIAL (INSTR. 3) DAY/ ---------- AMOUNT (A) OR PRICE (INSTR. (I) OWNERSHIP YEAR) CODE V (D) 3 AND 4) (INSTR. 4) (INSTR. 4) --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- REMINDER: REPORT ON A SEPARATE LINE FOR EACH CLASS OF SECURITIES BENEFICIALLY OWNED DIRECTLY OR INDIRECTLY. (OVER) * IF THE FORM IS FILED BY MORE THAN ONE PERSON, SEE INSTRUCTION 4(B)(V).
FORM 4 (CONTINUED)
TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ----------------------------------------------------------------------------------------------------------------------------------- 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. ----------------------------------------------------------------------------------------------------------------------------------- Title and Ownership Number of Date Exer- Amount of Form of Derivative cisable and Underlying Number of Deriv- Securities Expiration Securities Price Derivative ative Conver- Trans- Acquired (A) Date (Month/ (Instr. 3 of Securities Security: sion or Trans- action or Disposed Day/Year) and 4) Deriv- Benefi- Direct Exercise action Code of (D) -------------- -------------- ative cially (D) or Nature of Title of Price of Date (Instr. (Instr. 3, Date Amount Secur- Owned at Indirect Indirect Derivative Deriv- (Month/ 8) 4 and 5) Exer- Expir- or Num- ity End of (I) Beneficial Security ative Day/ -------- ---------- cis- ation ber of (Instr. Month (Instr. Ownership (Instr. 3) Security Year) Code V (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4) ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- Series A Convertible Preferred Common Stock 1-for-1 7/25/02 J(1) 21,580 Immed. 12/17/08 Stock 21,580 $4.52(2) 21,580 D ----------------------------------------------------------------------------------------------------------------------------------- Right to Funding Common Note (3) 7/25/02 J(1) 2,813 Immed. None Stock 2,813 (3) 2,813 D ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: (1) On July 25, 2002, Allied Healthcare International Inc. (the "Company") consummated a reorganization (the "Reorganization") involving the Company and two of its U.K. subsidiaries, Allied Healthcare Group Limited ("Allied Healthcare (UK)") and Transworld Healthcare (UK) Limited ("TWUK"). In the Reorganization, equity interests in TWUK and subordinated promissory notes (and payment in kind interest thereon) of Allied Healthcare (UK) were exchanged for (a) shares of Common Stock of the Company, (b) shares of Series A Convertible Preferred Stock of the Company or (c) the right to receive funding notes of Allied Healthcare (UK), which funding notes are convertible into shares of Common Stock of the Company. (2) In the Reorganization, Ms. Eames exercised 61,869 equity warrants of TWUK, paying the exercise price thereof through the tender of subordinated promissory notes of Allied Healthcare (UK) in the principal amount of (pounds sterling)61,869 (approximately $97,468 as of July 25, 2002), and received 61,869 ordinary shares of TWUK. Each such ordinary share was exchanged in the Reorganization for 0.3488 shares of Series A Convertible Preferred Stock of the Company. Accordingly, Ms. Eames was issued 21,580 shares of Series A Preferred Stock in the Reorganization at a purchase price of $4.52 per share of Series A Convertible Preferred Stock. (3) As a result of the consummation of the Reorganization, Ms. Eames is entitled to require Allied Healthcare (UK) to issue her a funding note in satisfaction of (pounds sterling)16,130 (approximately $25,411 as of July 25, 2002) of accrued and unpaid payment in kind interest on subordinated promissory notes issued by Allied Healthcare (UK). The principal amount of the funding note shall be equal to the amount of such accrued and unpaid interest. The funding note is exchangeable for shares of Common Stock of the Company at the ratio of 0.3488 shares of Common Stock for every (pounds sterling)2.00 in principal amount of funding note. /s/ Sarah L. Eames August 15, 2002 ---------------------------------------- -------------------- ** Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).