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SEC FORM 5/A SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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: 3235-0362
Estimated average burden
hours per response: 1.0
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
Form 3 Holdings Reported.
X
 Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
William H.C. Chang & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006
(Last) (First) (Middle)
C/O SEMLER SCIENTIFIC, INC.
2340-2348 WALSH AVENUE, SUITE 2344
(Street)
SANTA CLARA CA 95051
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Semler Scientific, Inc. [ SMLR ] 		5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2020
4. If Amendment, Date of Original Filed (Month/Day/Year)
02/16/2021 		6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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 at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 09/03/2020 G4 70,101 D $0 379,899 D(1)
Common Stock 09/03/2020 G4 70,101 D $0 379,899 D(2)
Common Stock 09/03/2020 G4 140,202 A $0 532,525 D(3)
Common Stock 10/09/2020 G4 29,523 D $0 350,376 D(1)
Common Stock 10/09/2020 G4 29,523 D $0 350,376 D(2)
Common Stock 10/09/2020 G4 59,046 A $0 591,571 D(3)
Common Stock 12/04/2020 G4 171,618 D $0 419,953 D(3)
Common Stock 12/09/2020 G4 2,416 D $0 417,537 D(3)
Common Stock 12/09/2020 G4 2,416 A $0 2,416 I(4) By Limited Liability Company
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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
William H.C. Chang & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006
(Last) (First) (Middle)
C/O SEMLER SCIENTIFIC, INC.
2340-2348 WALSH AVENUE, SUITE 2344
(Street)
SANTA CLARA CA 95051
(City) (State) (Zip)
1. Name and Address of Reporting Person*
Chang William H
(Last) (First) (Middle)
C/O SEMLER SCIENTIFIC, INC.
2340-2348 WALSH AVENUE, SUITE 2344
(Street)
SANTA CLARA CA 95051
(City) (State) (Zip)
1. Name and Address of Reporting Person*
Chang Diana Shon
(Last) (First) (Middle)
C/O SEMLER SCIENTIFIC, INC.
2340-2348 WALSH AVENUE, SUITE 2344
(Street)
SANTA CLARA CA 95051
(City) (State) (Zip)
1. Name and Address of Reporting Person*
Chang 2020 GP LLC
(Last) (First) (Middle)
C/O SEMLER SCIENTIFIC, INC.
2340-2348 WALSH AVENUE, STE. 2344
(Street)
SANTA CLARA CA 95051
(City) (State) (Zip)
Explanation of Responses:
1. Shares are held in six GRATs, for which Mr. Chang acts as sole Trustee and has voting and investment control.
2. Shares are held in six GRATs, for which Mrs. Chang acts as sole Trustee and has voting and investment control.
3. Shares are held directly by William H.C. Chang & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006.
4. Shares are held by Chang 2020 GP LLC, for which Mr. and Mrs. Chang are the sole managers and share voting and investment control.
Remarks:
This amendment is being filed solely to include Chang 2020 GP LLC as a co-filer to the original Form 5 filing.
/s/ William H.C. Chang, Co-Trustee 02/24/2021
/s/ William H.C. Chang 02/24/2021
/s/ Diana Shon Chang 02/24/2021
/s/ William H.C. Chang, Manager 02/24/2021
** 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.
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