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Li Chuwan Hau – ‘4’ for 2/13/15 re: China United Insurance Service, Inc.

On:  Wednesday, 4/12/17, at 11:09am ET   ·   For:  2/13/15   ·   Accession #:  1144204-17-20124   ·   File #:  0-54884

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 4/12/17  Li Chuwan Hau                     4                      1:11K  China United Ins Service, Inc.    Toppan Merrill/FA

Statement of Changes in Beneficial Ownership of Securities by an Insider   —   Form 4   —   SEA’34
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 4           Ownership Document -- v463171_4.xml/3.6             HTML      3K


        

This ‘4’ Document is an XML Data File that may be rendered in various formats:

  Form 4    –   Plain Text   –  SEC Website  –  EDGAR System  –    XML Data    –  <?xml?> File
 
 
SEC Info℠ rendering:  Ownership Document
 
FORM 4UNITED 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
OMB APPROVAL
OMB Number:3235-0287
Estimated average burden
hours per response:0.5
  
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*
LI CHUWAN HAU
(Last)(First)(Middle)
7F, NO. 88, CHANG'AN W. RD.
DATONG DIST.
(Street)
TAIPEI CITYF5103
(City)(State)(Zip)
2. Issuer Name and Ticker or Trading Symbol
China United Insurance Service, Inc. [ CUII ] 		5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
XDirector 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
2/13/15
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
XForm 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)
CodeVAmount(A) or (D)Price
Common Stock 3/31/15M 352,166A (1)1,352,166D
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)
CodeV(A)(D)Date ExercisableExpiration DateTitleAmount or Number of Shares
Call Option (Right to Buy) (1) 2/13/15A 1 2/13/15 8/13/15Common Stock352,166 (1)0D
Call Option (Right to Buy) (1) 3/31/15M 1 2/13/15 8/13/15Common Stock352,166 (1)0D
Put Option (Right to Sell) (2) 2/28/16A 1 2/28/16 8/8/16Common Stock352,166$0 (2)0D
Put Option (Right to Sell) (2) 8/8/16J (2) 1 2/28/16 8/8/16Common Stock352,166$0 (2)0D
Explanation of Responses:
(1)  Pursuant to the terms of an acquisition agreement (the "Acquisition Agreement"), on February 13, 2015 the Reporting Person received from the Issuer the right to acquire 352,166 shares of Common Stock of the Issuer in exchange for 352,166 shares of Action Holdings Financial Limited (the "AHFL Shares") to be transferred by the Reporting Person to the Issuer (the "Call Option"). The Acquisition Agreement did not assign a dollar value to the shares of Common Stock, the AHFL Shares, the Call Option or the property transferred by the Reporting Person to the Issuer in the transaction. The Reporting Person exercised the Call Option on March 31, 2015 in exchange for the AHFL Shares.
(2)  The Issuer and the Reporting Person amended (the "Amendment") the Acquisition Agreement on February 17, 2016 to provide that if the Issuer did not achieve certain goals by February 28, 2016, the Reporting Person would have the right to put back to the Issuer 352,166 shares of Common Stock of the Issuer in exchange for 352,166 shares of Action Holdings Financial Limited then held by the Issuer (the "Put Option"). The Issuer did not achieve the goals and on February 28, 2016 the Put Option became exercisable by the Reporting Person. On August 8, 2016, the Amendment was subsequently terminated and as a result the Put Option was cancelled with no value received.
/s/ Chuwan Hau Li 4/11/17
** Signature of Reporting PersonDate
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.
____________
Transaction Codes:
    A    Grant, award or other acquisition pursuant to Rule 16b-3(d).
    J    Other acquisition or disposition.
    M    Exercise or conversion of derivative security exempted pursuant to Rule 16b-3.

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