SEC FORM 4 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*
SALKA SUSAN R

(Last) (First) (Middle)
8840 CYPRESS WATERS BLVD., SUITE 300

(Street)
COPPELL TX 75019

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
AMN HEALTHCARE SERVICES INC [ AMN ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
3. Date of Earliest Transaction (Month/Day/Year)
12/16/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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
Common Stock 12/16/2021 M(1) 6,476 A $0.00 31,473 D
Common Stock 12/16/2021 F(2) 2,549 D $114.39 28,924 D
Common Stock 12/16/2021 M(1) 6,849 A $0.00 35,773 D
Common Stock 12/16/2021 F(2) 2,696 D $114.39 33,077 D
Common Stock 12/17/2021 M(1) 7,543 A $0.00 40,620 D
Common Stock 12/17/2021 F(2) 2,969 D $113.73 37,651(3) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Restricted Stock Units (4) 12/16/2021 M 6,476 (5) (6) Common Stock 6,476 $0.00 13,149 D
Restricted Stock Units (4) 12/16/2021 M 6,849 (7) (6) Common Stock 6,849 $0.00 7,057 D
Restricted Stock Units (4) 12/17/2021 M 7,543 (8) (6) Common Stock 7,543 $0.00 0 D
Explanation of Responses:
1. Common Stock acquired on the vesting of Restricted Stock Units (RSUs).
2. Number of shares withheld for tax purposes.
3. The number of shares reflected in this column does not include 101,243 vested RSUs that the Reporting Person elected to defer at the time of grant until her separation from service with the Company.
4. The RSUs reflected in this row were granted pursuant to the AMN Healthcare 2017 Equity Plan. Each Restricted Stock Unit represents a contingent right to receive one share of AMN Common Stock.
5. The RSUs reflected in this row were granted on December 16, 2020 and vest on the first, second and third anniversary of the grant date.
6. RSUs do not have an expiration date.
7. The RSUs reflected in this row were granted on December 16, 2019 and vest on the first, second and third anniversary of the grant date.
8. The RSUs reflected in this row were granted on December 17, 2018 and vest on the first, second and third anniversary of the grant date.
Remarks:
/s/ Susan R. Salka 12/20/2021
** 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.