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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 02/11/2015 | 3. Issuer Name and Ticker or Trading Symbol Inovalon Holdings, Inc. [ INOV ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 02/11/2015 | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Class B Common Stock | 4,522,595 | D | |
Class B Common Stock | 14,039,748(1) | I | By Lapis Ventures SAC Limited |
Class B Common Stock | 2,648,983(2) | I | By Lapis Ventures SAC Limited |
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) | 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 | ||||
Employee Stock Option (right to buy) | 08/15/2015 | 08/14/2024 | Class B Common Stock | 14,745 | 7.89 | D |
Explanation of Responses: |
1. Shares held by Lapis Ventures SAC Limited on behalf of Lapis Healthcare. Mr. Hoffmann has a direct pecuniary interest in 11,793,388 of such shares and an indirect pecuniary interest in an aggregate of 2,246,360 of such shares in which his children, who reside with him, have direct pecuniary interests. |
2. Shares held by Lapis Ventures SAC Limited on behalf of Lapis Data. Mr. Hoffmann has a direct pecuniary interest in such shares. |
Remarks: |
This Form 3/A is being filed to amend and restate in its entirety the Form 3 filed by Mr. Hoffmann on February 11, 2015, which had reported Mr. Hoffmann's beneficial ownership in all 24,212,100 shares held by Lapis Ventures SAC Limited, an investment vehicle through which Mr. Hoffmann holds a portion of his shares. Lapis Ventures SAC Limited continues to hold all of such shares as reported in the original Form 3. Mr. Hoffmann maintains a pecuniary interest in 16,688,731 of such shares, which number, in addition to his share ownership held otherwise directly, remains unchanged since the date of the original Form 3. |
/s/ Shauna L. Vernal, Attorney-in-Fact for Andre S. Hoffmann | 07/22/2015 | |
** 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. |