SEC Form 4 · accession 0001144204-17-020876
Summit Healthcare REIT, Inc
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Elizabeth A. Pagliarini
Officer — Chief Financial Officer
Period of report
Dec 2, 2016
Accepted (ET)
Apr 18, 2017 · 1:41 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001310383
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Incentive Stock Option (Right to Buy)F1,F2 | $2.02 | Dec 2, 2016 | A | 73,118 | A | — | Dec 1, 2026 | Common Stock | 73,118 | 73,118 | D |
Explanation of responses
- F1The options were granted pursuant to the Summit Healthcare REIT, Inc. 2015 Omnibus Incentive Plan.
- F2The options are exercisable as follows: (a) 24,373 commencing on December 2, 2016 (b) and the remaining 48,745 in 24 equal monthly installments commencing on January 1, 2016.