FORM 4 |
UNITED 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 |
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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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Integrated Healthcare Holdings [ IHCH.OB ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 01/31/2005 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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) | |||
Code | V | Amount | (A) or (D) | Price |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Common Stock Option (Right to Buy) | $0.3 | 01/31/2005 | J(1) | 50,000,000 | (2) | 11/16/2009 | Common Stock | 50,000,000 | (1) | 0 | D | ||||
Secured Convertible Promissory Note | $0.0031 | 01/31/2005 | J(1) | 160,000,000 | 09/28/2004 | 09/29/2005 | Common Stock | 160,000,000 | (1) | 0 | D | ||||
Stock Purchase Warrant (Right to Buy) | (3) | 01/31/2005 | J(1) | 60,000,000 | 01/31/2007 | 07/21/2008 | Common Stock | 60,000,000 | (1) | 0(4) | D |
Explanation of Responses: |
1. The option was granted pursuant to the First Amendment to Secured Convertible Note Purchase Agreement dated as of November 16, 2004 between the issuer and the reporting person. The Secured Convertible Promissory Note ("Note") was granted pursuant to the Secured Convertible Note Purchase Agreement dated as of September 28, 2004 between the issuer and the reporting person. The option and the Note were rescinded and cancelled pursuant to the Rescission, Restructuring, and Assignment Agreement dated January 31, 2005 ("Rescission Agreement") between the issuer, the reporting person and certain other parties. The reporting person was issued the Stock Purchase Warrant pursuant to the Rescission Agreement. |
2. The option would have become exercisable in whole or in part at any time on or after the date that Anil V. Shah, M.D. or his assignee or designee exercises the first tranche of an option as provided in Section 1.1(a) of a Purchase Option Agreement dated as of November 16, 2004 between the issuer and Dr. Shah. |
3. The exercise price for the first 34,538,153 shares purchased is $0.003125 per share. The exercise price for the remainder of the shares is $0.078 per share if exercised between 1/31/2007 and 7/30/2007, $0.11 per share if exercised between 7/31/2007 and 1/30/2008, and $0.15 per share thereafter. |
4. The warrant will not vest and become exercisable within 60 days after the date of this statement. |
Remarks: |
Kali P. Chaudhuri | 02/02/2005 | |
** 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. |