Amended Statement of Changes in Beneficial Ownership (4/a)
01 Abril 2022 - 3:33PM
Edgar (US Regulatory)
FORM 4
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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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
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SANFILIPPO ANTHONY MICHAEL |
2. Issuer Name and Ticker or Trading Symbol
TIVITY HEALTH, INC.
[
TVTY
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
701 COOL SPRINGS BLVD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/30/2021 |
(Street)
FRANKLIN, TN 37067
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
10/4/2021 |
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | | | | | | | | 482792 | D | |
Common Stock | | | | | | | | 15000 | I | By Spouse as Trustee for Monarch Trust |
Common Stock | | | | | | | | 240000 | I | By Self as Beneficiary of Vita Trust |
Common Stock | | | | | | | | 0 (1) | I | By Self as Trustee for Sanfilippo 2019 Grantor Retained Annuity Trust |
Common Stock | 9/30/2021 | | A | | 1626 (2) | A | $0 (3) | 15547 (1) | I | By Self as Trustee for Sanfilippo Family Trust |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 prior non-reportable transfer of 10,000 shares from the 2019 Sanfilippo Grantor Retained Annuity Trust to the Sanfilippo Family Trust. |
(2) | Reflects fully vested shares of common stock issued pursuant to the Tivity Health, Inc. Director Deferred Compensation Program, in lieu of an elected portion of the cash retainer fees earned for the director's service on the issuer's Board of Directors. The number of shares of common stock acquired was calculated by dividing the elected portion of the deferred cash retainer amount by the closing price of the issuer's common stock on the date the cash retainer was payable. |
(3) | This amendment is being filed solely to reflect a price of $0 for the reported transaction, which corrects an administrative error in the original Form 4. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
SANFILIPPO ANTHONY MICHAEL 701 COOL SPRINGS BLVD FRANKLIN, TN 37067 | X |
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Signatures
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/s/ Joseph Raymond Bilbao by power of attorney for Anthony Sanfilippo | | 4/1/2022 |
**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 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 control number. |
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