SEC FORM 4 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*
Freeman Robert Thomas

(Last) (First) (Middle)
C/O ALIGNMENT HEALTHCARE, INC. 1100 W.
TOWN & COUNTRY ROAD, SUITE 1600

(Street)
ORANGE CA 92868

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Alignment Healthcare, Inc. [ ALHC ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Financial Officer
3. Date of Earliest Transaction (Month/Day/Year)
03/25/2021
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, par value $0.001 per share ("Common Stock") 03/25/2021 A(1)(2) 57,090 A $0.00 223,347 D
Common Stock 03/25/2021 A(3) 15,142 A $0.00 238,489 D
Common Stock 03/25/2021 A(4) 45,427 A $0.00 924,564 I See footnote(5)
Common Stock 04/06/2021 S(6) 38,919 D $16.83 885,645 I See footnote(5)
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) $18 03/25/2021 A(7) 190,680 (8) 03/25/2031 Common Stock 190,680 $0.00 190,680 D
Stock Option (right to buy) $18 03/25/2021 A(9) 572,040 (8) 03/25/2031 Common Stock 572,040 $0.00 572,040 I See footnote(5)
Explanation of Responses:
1. Represents 38,060 shares of Common Stock of Alignment Healthcare, Inc. (the "Company") and 19,030 restricted shares of Common Stock of the Company that will vest upon a change of control of the Company or otherwise (A) if received in exchange for pre-IPO (as defined below) transaction-based stock appreciation rights, on the later of (x) the four-year anniversary of the initial vesting date, or (y) 50% on the first anniversary of Company's initial public offering (the "IPO") and 50% on the second anniversary of the IPO, in each case, subject to Ms. Freeman's continued employment or service on each such vesting date and (B) if received in exchange for pre-IPO service-based stock appreciation rights, and (Continued in Footnote 2)
2. (Continued From Footnote 1) (B) if received in exchange for pre-IPO service-based stock appreciation rights, according to the pre-IPO vesting schedule applicable to Mr. Freeman disclosed in the "Executive Compensation - Outstanding Equity Awards at Fiscal Year End" section of the Company's registration statement on Form S-1. The securities covered by such transaction were previously included on Mr. Freeman's Form 3.
3. Represents 15,142 restricted stock units, each restricted stock unit representing the right to receive one share of Common Stock of the Company, that will vest 25% on the first four anniversaries of the initial vesting date. The securities covered by such transaction were previously included on Mr. Freeman's Form 3.
4. Represents 45,427 restricted stock units, each restricted stock unit representing the right to receive one share of Common Stock of the Company, that will vest 25% on the first four anniversaries of the initial vesting date. The securities covered by such transaction were previously included on Mr. Freeman's Form 3.
5. Represents securities held by FCO Holdings LLC, a limited liability company owned by FCO Holdings Trust One, an irrevocable trust of which Mr. Freeman is an indirect beneficiary.
6. Represents 38,919 shares of Common Stock sold pursuant to the partial exercise by the underwriters of their over-allotment option after the closing of the Company's initial public offering, at a price of $16.83 (net of underwriting discount).
7. Represents 190,680 options to purchase Common Stock of the Company at the initial public offering price. The securities covered by such transaction were previously included on Mr. Freeman's Form 3.
8. Vest 25% on the first four anniversaries of the initial vesting date.
9. Represents 572,042 options to purchase Common Stock of the Company at the initial public offering price. The securities covered by such transaction were previously included on Mr. Freeman's Form 3.
Remarks:
/s/ Richard A. Cross, as Attorney-in-Fact, for Robert Thomas Freeman 04/08/2021
** 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).
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