SEC Form 4 · accession 0001144204-17-020124

China United Insurance Service, Inc. · CUII

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Feb 13, 2015

Accepted (ET)

Apr 12, 2017 · 11:09 am EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001512927

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1	Mar 31, 2015	M	352,166	—	A	1,352,166	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Call Option (Right to Buy)^F1	—	Feb 13, 2015	A	1	A	Feb 13, 2015	Aug 13, 2015	Common Stock	352,166	D
Call Option (Right to Buy)^F1	—	Mar 31, 2015	M	1	D	Feb 13, 2015	Aug 13, 2015	Common Stock	352,166	D
Put Option (Right to Sell)^F2	—	Feb 28, 2016	A	1	A	Feb 28, 2016	Aug 8, 2016	Common Stock	352,166	D
Put Option (Right to Sell)^F2	—	Aug 8, 2016	J	1	D	Feb 28, 2016	Aug 8, 2016	Common Stock	352,166	D

F1Pursuant 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.
F2The 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.