SEC Form 4 · accession 0001209191-16-111810
Alliance HealthCare Services, Inc · AIQ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Neil F Dimick
Director
Period of report
Apr 1, 2016
Accepted (ET)
Apr 1, 2016 · 6:25 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000817135
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Apr 1, 2016 | M | 1,112 | — | A | 57,012 | D | |
| Common StockF1 | Apr 1, 2016 | D | 1,112 | $18.50 | D | 55,900 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Phantom StockF1,F2 | — | Apr 1, 2016 | M | 1,112 | D | Apr 1, 2016 | Apr 1, 2016 | Common Stock | 1,112 | 0 | D |
Explanation of responses
- F1Represents Phantom Stock acquired under the Issuer's Directors' Deferred Compensation Plan (the "Plan") under which each share of Phantom Stock represents the economic equivalent of one share of the Issuer's common stock. Pursuant to the Plan, in connection with the consummation of a change of control, the Phantom Stock was settled for cash on the transaction date reported herein.
- F2Gives effect to a 1-for-5 reverse split of common stock of the Issuer effected on December 26, 2012.