0001171843-15-005039.txt : 20150904
0001171843-15-005039.hdr.sgml : 20150904
20150904170658
ACCESSION NUMBER: 0001171843-15-005039
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150902
FILED AS OF DATE: 20150904
DATE AS OF CHANGE: 20150904
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: American CareSource Holdings, Inc.
CENTRAL INDEX KEY: 0001316645
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090]
IRS NUMBER: 200428568
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1170 PEACHTREE STREET, NE
STREET 2: SUITE 2350
CITY: ATLANTA
STATE: GA
ZIP: 30309
BUSINESS PHONE: 972-308-6830
MAIL ADDRESS:
STREET 1: 1170 PEACHTREE STREET, NE
STREET 2: SUITE 2350
CITY: ATLANTA
STATE: GA
ZIP: 30309
FORMER COMPANY:
FORMER CONFORMED NAME: American Caresource Holdings, Inc.
DATE OF NAME CHANGE: 20050615
FORMER COMPANY:
FORMER CONFORMED NAME: American Caresouce Holdings, Inc.
DATE OF NAME CHANGE: 20050204
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: PAPPAJOHN JOHN
CENTRAL INDEX KEY: 0000897464
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33094
FILM NUMBER: 151095003
MAIL ADDRESS:
STREET 1: 1660 WALT WHITMAN ROAD
STREET 2: SUITE 105
CITY: MELVILLE
STATE: NY
ZIP: 11747
4
1
formfour.xml
X0306
4
2015-09-02
0
0001316645
American CareSource Holdings, Inc.
ANCI
0000897464
PAPPAJOHN JOHN
C/O AMERICAN CARESOURCE HOLDINGS, INC.
1170 PEACHTREE STREET NE, SUITE 2350
ATLANTA
GA
30309
1
1
0
0
Acting Chief Executive Officer
Warrant to Purchase Common Stock, par value $0.01 per share
1.70
2015-09-02
4
A
0
150000
A
2020-08-12
Common Stock
150000
150000
D
Warrants are exercisable immediately.
Issued in consideration for providing a guarantee to a lender of up to $500,000 for an extension to an existing line of credit rendered to the company.
/s/ John Pappajohn
2015-09-04