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). U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 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(h) 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) -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Allied Healthcare International Inc. (ADH) ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Day/Year December 6, 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/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. 2A. 4. Securities Owner- 2. Deemed Securities Acquired (A) or Beneficially ship Trans- Execution 3. Disposed of (D) Owned Form: 7. action Date, Transaction (Instr. 3, 4 and 5) Following Direct Nature of Date if any Code ------------------------------- Reported (D) or Indirect 1. (Month/ (Month/ (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Day Day ------------ or (Instr. 3 & (I) Ownership (Instr. 3) Year) Year) Code V Amount (D) Price Instr.4) (Instr.4) (Instr.4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/6/02 J(1) 2,813 A $9.03(1) 493,912(2) D ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== (Over) Page 1 of 2
FORM 4 (continued) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ================================================================================
9. Number 10. of Owner- Deriv- ship ative Form 2. Secur- of Conver- 5. 7. ities Deriv- 11. sion Number of Title and Amount Bene- ative Nature or Derivative 6. of Underlying 8. ficially Secur- of Exer- 3A. 4. Securities Date Securities Price Owned ities: In- cise Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Follow- Direct direct Price 3. Execut- action or Disposed Expiration Date ---------------- Deriv- ing (D) or Bene- 1. of Trans- ion Code of(D) (Month/Day/Year) Amount ative Reported In- ficial Title of Deriv- action Date if (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner- Derivative ative Date any 8) 4 and 5) Date Expira- Number ity action(s) (I) ship Security Secur- (Month/ (Month/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Day/Year) Day/Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ Right to Funding Note (right to acquire Funding Note representing the right to acquire Common Common Stock) $0.00(1) 12/6/02 J(1) 2,813 7/25/02 None Stock 2,813 0 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== 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"). The net effect of the Reorganization was that TWUK became a wholly-owned subsidiary of the Company and all of the senior subordinated promissory notes (the "Promissory Notes") of Allied Healthcare (UK) were replaced by Series A Convertible Preferred Stock of the Company. The Reorganization was effected pursuant to a Reorganization Agreement (the "Reorganization Agreement"), dated as of April 24, 2002, as amended on May 16, 2002 and June 26, 2002, among the Company, Allied Healthcare (UK), TWUK and certain other persons. In the Reorganization, Ms. Eames was issued shares of Series A Convertible Preferred Stock of the Company in exchange for the principal amount of her Promissory Note. In addition, as a result of the consummation of the Reorganization and pursuant to the provisions of the Reorganization Agreement, accrued and unpaid payment-in-kind ("PIK") interest through June 17, 2002 in the amount of (pound sterling) 16,130 (approximately $25,411 as of July 25, 2002) on the Promissory Note held by Ms. Eames was exchanged for shares of Common Stock of the Company in accordance with the following procedure: (a) PIK interest on the Promissory Note ceased to accrue as of June 17, 2002, the date specified in the Reorganization Agreement; (b) Allied Healthcare (UK) was obligated to issue to Ms. Eames a funding note ("Funding Note") in the principal amount of the accrued PIK interest on her Promissory Note through June 17, 2002; and (c) when issued, the Funding Note was exchanged for shares of Common Stock of the Company at the ratio of 0.3488 shares of Common Stock for every (pound sterling) 2.00 in principal amount of the Funding Note. In accordance with the foregoing, on December 6, 2002, Allied Healthcare (UK) issued Ms. Eames a Funding Note in the principal amount of (pound sterling) 16,130 and, on the same date, such Funding Note was exchanged for 2,813 shares of Common Stock. As a result of the foregoing, Ms. Eames exchanged (pound sterling) 16,130 (approximately $25,411 as of July 25, 2002) in PIK interest for 2,813 shares of Common Stock of the Company, resulting in a purchase price of $9.03 per share of Common Stock. (2) Excludes 310,000 shares of Common Stock subject to options held by Ms. Eames, 250,000 of which are exercisable as of the date hereof, and 21,580 shares of Common Stock issuable upon the conversion of the 21,580 shares of Series A Convertible Preferred Stock of the Company held by Ms. Eames. /s/ Sarah L Eames December 8, 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).