SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| 500 11TH AVENUE NORTH |
| SUITE 1000 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
05/30/2023
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3. Issuer Name and Ticker or Trading Symbol
HEALTHSTREAM INC
[ HSTM ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Stock Holding |
0 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
|
/s/ A. Alex Jahangir |
06/13/2023 |
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** 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
5
(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. |
LIMITED POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that Amir Alex Jahangir has made, constituted
and appointed, and by these presents does make, constitute and appoint Scott
Roberts, Amelia Emmert, or Rory Spurlock as its true and lawful attorney-in-
fact, for its and in its name, place and stead, and for its use and benefit,
to do all things and to execute all documents necessary to ensure compliance
with Section 16 reporting requirements associated with my relationship with
HealthStream, Inc.
It is my intention by this instrument to grant unto said attorney-in-fact full
power and authority to do and perform all and every act and thing whatsoever
to accomplish the foregoing grant of power as shall be necessary to be done on
my behalf as fully to all intents and purposes as I might or could do if I was
present in person.
This power of attorney may be revoked by the undersigned only by specific
revocation endorsed or written hereon, and until such revocation be endorsed
or written hereon, all persons may rely upon this power of attorney as being
in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand, the 8th day of June, 2023.
/s/ Amir Alex Jahangir
_______________________________
Amir Alex Jahangir
