Statement of Changes in Beneficial Ownership (4)
10 December 2022 - 5:17AM
Edgar (US Regulatory)
FORM 4
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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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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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1. Name and Address of Reporting Person
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Davies Thomas |
2. Issuer Name and Ticker or Trading Symbol
AKUMIN INC.
[
AKU
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O AKUMIN INC., 8300 W. SUNRISE BOULEVARD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/8/2022 |
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(Street)
PLANTATION, FL 33322
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common Stock | 12/8/2022 | | M | | 150000 | A | $0.50 | 301992 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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) | $0.50 | 12/8/2022 | | M | | | 150000 | (1) | 3/15/2026 | Common Stock | 150000 | $0.00 | 0 | D | |
| Stock Option (right to buy) | $3.74 | | | | | | | (2) | 11/16/2025 | Common Stock | 50000 | | 50000 | D | |
| Stock Option (right to buy) | $3.29 | | | | | | | (3) | 11/18/2026 | Common Stock | 52213 | | 52213 | D | |
| Explanation of Responses: |
| (1) | The Reporting Person was granted 150,000 Stock Options on March 15, 2016 under the Company's Amended and Restated Stock Option Plan (the "Option Plan"). One-hundred percent of the Stock Options have vested. |
| (2) | The Reporting Person was granted 50,000 Stock Options on November 16, 2018 under the Option Plan. One-hundred percent of the Stock Options have vested. |
| (3) | The Reporting Person was granted 52,213 Stock Options on November 18, 2019 under the Option Plan. One-hundred percent of the Stock Options have vested. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Davies Thomas
C/O AKUMIN INC.
8300 W. SUNRISE BOULEVARD
PLANTATION, FL 33322 | X |
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Signatures
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| /s/ Thomas P. Conaghan, Attorney-in-Fact | | 12/9/2022 |
| **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 control number. |
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