Statement of Changes in Beneficial Ownership (4)
03 März 2023 - 11:20PM
Edgar (US Regulatory)
FORM 4
[ ] 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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OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
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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 * Shepardson Robert |
2. Issuer Name and Ticker or Trading
Symbol American Well Corp [ AMWL ] |
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 |
(Last)
(First)
(Middle)
C/O AMERICAN WELL CORPORATION, 75 STATE STREET, 26TH
FLOOR |
3. Date of Earliest Transaction (MM/DD/YYYY)
3/1/2023
|
(Street)
BOSTON, MA 02109
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. 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 |
Class A Common Stock |
3/1/2023 |
|
S(1) |
|
56858 |
D |
$2.7443 |
836847 |
D |
|
Class A Common Stock |
3/1/2023 |
|
A |
|
274378 (2) |
A |
$0.00 |
1111225 |
D |
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
Performance Share Units |
(3) |
3/1/2023 |
|
A |
|
274378 |
|
(3) |
(3) |
Class A Common Stock |
274378 |
$0.00 |
274378 |
D |
|
Explanation of
Responses: |
(1) |
The sales reported in this
Form 4 were made in order to pay the tax liability arising from the
vesting and settlement of restricted stock units on March 1, 2023.
The sale was effected through an automatic "sell to cover"
transaction that did not represent a discretionary trade by the
reporting person. |
(2) |
Represents a grant of
restricted stock units, with 25% vesting upon the first anniversary
of the grant date ("Initial Vesting Date"), and the remaining
vesting every 3 months thereafter over a three-year period
(beginning on the first calendar day of the month following the
date that is three months following the Initial Vesting
Date). |
(3) |
Each Performance Share Unit
represents a contingent right to receive one share of Class A
Common Stock of the Issuer. The Performance Share Units are
eligible to vest over a three-year performance period ending
February 28, 2026, and may be earned between 0%-150% of target
levels, based upon the Issuer's achievement of specified stock
price performance thresholds, subject to the reporting person's
continued employment through the date on which performance is
certified. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Shepardson Robert
C/O AMERICAN WELL CORPORATION
75 STATE STREET, 26TH FLOOR
BOSTON, MA 02109 |
|
|
Chief Financial Officer |
|
Signatures
|
/s/ Bradford Gay, as attorney-in-fact for Robert
Shepardson |
|
3/3/2023 |
**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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