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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 11/28/2006 |
3. Issuer Name and Ticker or Trading Symbol
Integrated Healthcare Holdings Inc [ IHCH.OB ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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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)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
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) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Common Stock Warrant (Right to Buy) | 01/27/2007 | 07/26/2008 | Common Stock | 60,000,000(1) | (2) | D |
Explanation of Responses: |
1. The maximum number of shares issuable upon exercise of the warrant is the lesser of 60,000,000 and 20% of the issuer's Fully-Diluted shares outstanding (as defined in the Amended Rescission Agreement). |
2. The per share exercise price for the first 34,538,153 shares purchased is $0.003125. The per share exercise price for the remaining shares is $0.078 if exercised between January 27, 2007 and July 26, 2007, $0.11 if exercised between July 27, 2007 and January 26, 2008, and $0.15 per share thereafter. |
Remarks: |
The warrant was issued to the reporting person pursuant to a Rescission, Restructuring and Assignment Agreement dated January 27, 2005 between the issuer, the reporting person and certain other parties, as amended by the Payment Agreement dated January 31, 2005 between the same parties (collectively, the "Amended Rescission Agreement") and will first become exercisable on January 27, 2007, which date is 60 days after the date shown in Box 2 at the top of page 1. |
/s/ Kali P. Chaudhuri | 12/06/2006 | |
** 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 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. |