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*
1230 PEACHTREE STREET NE |
SUITE 600 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 04/06/2016
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3. Issuer Name and Ticker or Trading Symbol
STREAMLINE HEALTH SOLUTIONS INC.
[ STRM ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
SVP & Chief Growth Officer |
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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, $.01 par value |
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: |
Remarks: |
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Jack W. Kennedy Jr., Attorney-in-Fact |
04/08/2016 |
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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 FOR SECTION 13 AND SECTION 16 FILINGS
I, Shaun L. Priest, do hereby make, constitute and appoint each of Jack W.
Kennedy Jr., Nicholas A. Meeks, and Michael Halloran, and each of them acting
individually, my true and lawful attorneys for the purposes hereinafter set
forth, effective as of this 18th day of March, 2016.
References in this limited power of attorney to "my Attorney" are to each of
the persons named above and to the person or persons substituted hereunder
pursuant to the power of substitution granted herein.
I hereby grant to my Attorney, for me and in my name, place and stead, the
power:
1. To execute for and on my behalf, in my capacity as a stockholder of
Streamline Health Solutions, Inc., a Delaware corporation (the "Company"),
Schedule 13D and Schedule 13G, and all and any amendments thereto, in accordance
with Section 13 of the Securities Exchange Act of 1934 and the rules and
regulations promulgated thereunder (the "Exchange Act");
2. To execute for and on my behalf, in my capacity as an officer, director or
stockholder of the Company, Form ID, Form 3, Form 4, and Form 5, and all and any
amendments thereto, in accordance with Section 16(a) of the Exchange Act;
3. To do and perform any and all acts for and on my behalf that may be necessary
or desirable to complete and execute any such Schedule 13D, Schedule 13G, Form
ID, Form 3, Form 4 and Form 5 or any amendment thereto, and to timely file such
schedule, form or amendment thereto with the United States Securities and
Exchange Commission (the "SEC") and any stock exchange or similar authority; and
4. To take any other action of any type whatsoever that, in the opinion of my
Attorney, may be necessary or desirable in connection with the foregoing grant
of authority, it being understood that the documents executed by my Attorney
pursuant to this limited power of attorney shall be in such form and shall
contain such terms and conditions as my Attorney may approve.
I hereby grant to my Attorney full power and authority to do and to perform any
and every act and thing whatsoever requisite, necessary or proper to be done in
the exercise of any of the rights and powers herein granted, as fully to all
intents and purposes as I might or could do if personally present, with full
power of substitution or revocation, hereby ratifying and confirming all that my
Attorney shall lawfully do or cause to be done by virtue of this limited power
of attorney and the rights and powers herein granted. I acknowledge and agree
that neither my Attorney nor the Company is assuming any of my responsibilities
to comply with the Exchange Act.
This limited power of attorney shall remain in full force and effect until I am
no longer required to file any of Schedule 13D, Schedule 13G, Form 3, Form 4 or
Form 5 with respect to my holdings of, and transactions in, securities of the
Company, unless earlier revoked by me in a signed writing delivered to each of
my Attorneys and substitutes therefor, if any. This limited power of attorney
may be filed with the SEC as a confirming statement of the authority granted
herein.
IN WITNESS WHEREOF, I have hereunto set my hand to this instrument on the date
first written above.
/s/ SHAUN L. PRIEST
Shaun L. Priest
State of Georgia
County of Cobb
Subscribed and sworn to before me on this 18th day of March, 2016 by Shaun L.
Priest.
/s/ CAROL ANN DONOFRIO
Notary Public
[SEAL]