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) 01/01/2022 | 3. Issuer Name and Ticker or Trading Symbol AKUMIN INC. [ AKU ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. 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 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) |
Common Stock | 16,829 | D | |
Common Stock(1) | 21,008 | D | |
Common Stock(2) | 300,000 | I | By LK Family Limited Partnership |
Common Stock(2) | 1,586,545 | I | By Laurel Enterprises, LLC |
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 | ||||
Stock Option (right to buy) | (3) | 11/16/2025 | Common Stock | 50,000 | 3.74 | D | |
Stock Option (right to buy) | (4) | 11/18/2026 | Common Stock | 52,213 | 3.29 | D |
Explanation of Responses: |
1. The Reporting Person was granted 21,008 Restricted Share Units on March 9, 2021 under the Company's Amended and Restated Restricted Share Unit Plan (the "RSU Plan). Fifty percent of the Restricted Share Units will vest on March 9, 2022. The remaining 50% will vest on March 9, 2023. |
2. The Reporting person exercises voting rights and has the right to dispose of shares held by LK Family Limited Partnership and Laurel Enterprises, LLC. |
3. The Reporting Person was granted 50,000 Stock Options on November 16, 2018 under the Company's Amended and Restated Stock Option Plan (the "Option Plan"). One-hundred percent of the Stock Options have vested. |
4. The Reporting Person was granted 52,213 Stock Options on November 18, 2019 under the Option Plan. Sixty-seven percent of the Stock Options have vested. The remaining 33% will vest on November 18, 2022. |
Remarks: |
Exhibit List - Exhibit 24 - Power of Attorney |
/s/ Thomas P. Conaghan as attorney-in-fact for James Harold Webb | 01/03/2022 | |
** 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. |