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*
Orange County Physicians Investment Network, LLC

(Last) (First) (Middle)
2621 SOUTH BRISTOL STREET, SUITE 304

(Street)
SANTA ANA CA 92704

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Integrated Healthcare Holdings Inc [ IHCH.OB ]
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)
12/31/2005
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 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 02/04/2005 P4 5,400,000(1) A $0.2587 96,100,000 D
Common Stock 10/31/2005 J4 40,626,684(2) D $0.2587 55,473,316 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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Right to Acquire $0.2587 12/14/2005 4J 25,901,447 (3) 01/13/2006(3) Common Stock 25,901,447 $0 25,901,447 D
Explanation of Responses:
1. The shares were acquired pursuant to the Stock Purchase Agreement dated January 28, 2005, which conditioned the sale and issuance of the shares upon the issuance of certain licenses.
2. Forfeiture of the shares held in escrow, pursuant to the Second Amendment to Stock Purchase Agreement dated October 31, 2005 between the Issuer and the Reporting Person, as a result of the failure by the Reporting Person to deliver the purchase price for the shares. The share price used to determine the number of shares forfeited was $0.2586728.
3. In connection with the settlement of Escrow Agreement tranasctions on October 31, 2005 the Issuer granted the Reporting Person the right to purchase up to $6,700,000 of common stock at a price of $.2586728 per share or a maximum of 25,901,447 shares of its common stock, plus interest on the purchase price at 14% per annum from September 12, 2005 through the date of closing on the funds from the Reporting Person. The right is exercisable only within the 30 calendar days following the termination of the Issuer's default pursuant to a loan agreement between the Issuer and a medical provider. The cure of the default occurred on December 14, 2005.
/s/ Anil V. Shah, M.D., Manager 02/13/2006
** 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.