SEC FORM
3
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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
1100 W. TOWN & COUNTRY RD. |
SUITE 1600 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 08/15/2023
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3. Issuer Name and Ticker or Trading Symbol
Alignment Healthcare, Inc.
[ ALHC ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
Chief Clinical Officer |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Common Stock |
1,533,399
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D |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Options (Right to Buy) |
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03/25/2031 |
Common Stock |
115,954 |
18 |
D |
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Explanation of Responses: |
Remarks: |
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/s/ Christopher J. Joyce, as Attorney-in-Fact, for Donald S. Furman |
08/22/2023 |
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** 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). |
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 Number. |
SUBSTITUTE POWER OF ATTORNEY
Under the terms of the powers of attorney listed on Exhibit A attached hereto
(the "Powers of Attorney") the undersigned, Richard A. Cross, was appointed
attorney-in-fact for the individuals named in the Powers of Attorney (the
"Section 16 Filers"), to, among other things, execute for and on behalf of the
Section 16 Filers any required Form 3, 4 and 5 in accordance with Section 16(a)
of the Securities Exchange Act of 1934, as amended, and the rules thereunder.
In accordance with the authority granted under the Powers of Attorney, including
the power of substitution, the undersigned hereby appoints Christopher J. Joyce
as substitute attorney-in-fact, on behalf of each of the Section 16 Filers, with
the power to act without any other and with full power of substitution, to
exercise and execute all of the powers granted or conferred in the original
Powers of Attorney. By his signature as attorney-in-fact to this Substitute
Power of Attorney, Christopher J. Joyce accepts such appointment and agrees to
assume from the undersigned any and all duties and responsibilities attendant to
his capacity as attorney-in-fact.
Date: August 22, 2023
By: /s/ Richard A. Cross
Richard A. Cross
Attorney-in-Fact
I ACCEPT THIS APPOINTMENT
AND SUBSTITUTION:
/s/ Christopher J. Joyce
Christopher J. Joyce
Exhibit A
Power of Attorney of Donald S. Furman dated November 23, 2021