SEC FORM 3/A SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
KAO JOHN E

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

(Street)
ORANGE CA 92868

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/26/2021
3. Issuer Name and Ticker or Trading Symbol
Alignment Healthcare, Inc. [ ALHC ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
03/26/2021
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock, par value $0.001 per share ("Common Stock") 4,285,037(1) I See Footnote(2)
Common Stock 311,030(3) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to buy) (4) 03/25/2031 Common Stock 3,916,668 18 D
Explanation of Responses:
1. Represents 2,797,642 shares of Common Stock of Alignment Healthcare, Inc. (the "Company") and 1,487,395 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 incentive units, 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 Mr. Kao's continued employment or service on each such vesting date and (B) if received in exchange for pre-IPO service-based incentive units according to the pre-IPO vesting schedule applicable to Mr. Kao disclosed in the "Executive Compensation - Outstanding Equity Awards at Fiscal Year End" section of the Company's registration statement on Form S-1.
2. Represents securities held by JEK Trust, dated February 8, 2021, of which Mr. Kao is the trustee.
3. Represents 311,030 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.
4. Vest 25% on the first four anniversaries of the initial vesting date.
Remarks:
This Form 3 amends and restates in its entirety the Form 3 filed by Mr. Kao on March 26, 2021. The purpose of this Form 3 is to correct the form of ownership of 311,030 restricted stock units and 3,916,668 stock options which were inadvertently reported as being held indirectly in the original Form 3. Such restricted stock units and stock options are held directly by Mr. Kao. This amendment does not affect Mr. Kao's aggregate beneficial ownership of non-derivative and derivative securities of the Company.
/s/ Richard A. Cross, as Attorney-in-Fact, for John E. Kao 05/13/2021
** 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 5 (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).
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