| 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*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol China United Insurance Service, Inc. [ CUII ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 02/13/2015 | ||||||||||||||||||||||||||
| 4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 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 | 03/31/2015 | M | 352,166 | A | (1) | 1,352,166 | D | |||
| Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 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 | ||||||||
| Call Option (Right to Buy) | (1) | 02/13/2015 | A | 1 | 02/13/2015 | 08/13/2015 | Common Stock | 352,166 | (1) | 0 | D | ||||
| Call Option (Right to Buy) | (1) | 03/31/2015 | M | 1 | 02/13/2015 | 08/13/2015 | Common Stock | 352,166 | (1) | 0 | D | ||||
| Put Option (Right to Sell) | (2) | 02/28/2016 | A | 1 | 02/28/2016 | 08/08/2016 | Common Stock | 352,166 | $0(2) | 0 | D | ||||
| Put Option (Right to Sell) | (2) | 08/08/2016 | J(2) | 1 | 02/28/2016 | 08/08/2016 | Common Stock | 352,166 | $0(2) | 0 | D | ||||
| Explanation of Responses: |
| 1. Pursuant to the terms of an acquisition agreement (the "Acquisition Agreement"), on February 13, 2015 the Reporting Person received from the Issuer the right to acquire 352,166 shares of Common Stock of the Issuer in exchange for 352,166 shares of Action Holdings Financial Limited (the "AHFL Shares") to be transferred by the Reporting Person to the Issuer (the "Call Option"). The Acquisition Agreement did not assign a dollar value to the shares of Common Stock, the AHFL Shares, the Call Option or the property transferred by the Reporting Person to the Issuer in the transaction. The Reporting Person exercised the Call Option on March 31, 2015 in exchange for the AHFL Shares. |
| 2. The Issuer and the Reporting Person amended (the "Amendment") the Acquisition Agreement on February 17, 2016 to provide that if the Issuer did not achieve certain goals by February 28, 2016, the Reporting Person would have the right to put back to the Issuer 352,166 shares of Common Stock of the Issuer in exchange for 352,166 shares of Action Holdings Financial Limited then held by the Issuer (the "Put Option"). The Issuer did not achieve the goals and on February 28, 2016 the Put Option became exercisable by the Reporting Person. On August 8, 2016, the Amendment was subsequently terminated and as a result the Put Option was cancelled with no value received. |
| /s/ Chuwan Hau Li | 04/11/2017 | |
| ** 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 Number. | ||
