SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol American Healthcare REIT, Inc. [ NONE ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 10/01/2021 | ||||||||||||||||||||||||||
4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Class I Common Stock | 10/01/2021 | A | 185,809 | A | (1) | 248,498 | I | By Streiff Family Trust UA DTD 03/26/2013(2) | ||
Class I Common Stock | 10/01/2021 | A | 20,591 | A | (1) | 20,591 | I | By Griffin-American Healthcare REIT III Advisor, LLC(3) | ||
Class I Common Stock | 10/01/2021 | J | 20,591 | D | $9.22 | 0 | I | By Griffin-American Healthcare REIT III Advisor, LLC(4) | ||
Class T Common Stock | 10/01/2021 | J | 20,833 | D | $9.22 | 0 | I | By Griffin-American Healthcare REIT IV Advisor, LLC(5) | ||
Class T Common Stock | 10/04/2021 | A | 69,143(6) | A | $0 | 69,143 | D | |||
Class T Common Stock | 47,783 | I | By Streiff Family Trust UA DTD 03/26/2013(2) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. Reflects the acquisition of shares of the Issuer's common stock in connection with the merger (the "Merger") of Griffin-American Healthcare REIT III, Inc. ("GAHR III") with and into Continental Merger Sub, LLC, a wholly-owned subsidiary of American Healthcare REIT, Inc. ("AHR"). In the Merger, each share of GAHR III's common stock, par value $0.01 per share, was converted into the right to receive 0.9266 shares of the Issuer's Class I common stock, par value $0.01 per share ("AHR Class I Common Stock"). There is no established market for shares of AHR Class I Common Stock. On March 18, 2021, the board of directors of AHR approved an estimated value per share of AHR Class I Common Stock of $9.22. |
2. The reported shares of common stock are held directly by Streiff Family Trust UA DTD 03/26/2013, and indirectly by Mathieu B. Streiff, Trustee. |
3. The reported shares of common stock are owned by Griffin-American Healthcare REIT III Advisor, LLC ("GAHRIII Advisor"), which is 75% owned and managed by wholly owned subsidiaries of American Healthcare Investors, LLC ("American Healthcare Investors"). Mr. Streiff serves as a managing director of American Healthcare Investors, and as such, may be deemed to be the beneficial owner of such common stock. Mr. Streiff disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein. |
4. In connection with the Merger, after the shares of common stock owned by GAHRIII Advisor were converted into the right to receive AHR Class I Common Stock pursuant to footnote (1) above, the shares owned by GAHRIII Advisor were then redeemed by the Issuer for $9.22 per share. GAHRIII Advisor is 75% owned and managed by wholly owned subsidiaries of American Healthcare Investors. Mr. Streiff serves as a managing director of American Healthcare Investors, and as such, may be deemed to have been the beneficial owner of such common stock. Mr. Streiff disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein. |
5. In connection with the Merger, the shares owned by Griffin-American Healthcare REIT IV Advisor, LLC ("GAHRIV Advisor") were redeemed by the Issuer for $9.22 per share. Mr. Streiff serves as a managing director of American Healthcare Investors, the managing member of GAHRIV Advisor, and as such, may be deemed to have been the beneficial owner of such common stock. Mr. Streiff disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein. |
6. The Reporting Person was granted 69,143 shares of restricted Class T common stock on October 4, 2021. The shares of restricted Class T common stock vest in three equal annual installments on October 1, 2022, October 1, 2023 and October 1, 2024 (subject to continuous employment through each vesting date). |
Remarks: |
/s/ MATHIEU B. STREIFF | 10/05/2021 | |
** 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 4 (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. |