0001171843-15-006768.txt : 20151211
0001171843-15-006768.hdr.sgml : 20151211
20151211141124
ACCESSION NUMBER: 0001171843-15-006768
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151209
FILED AS OF DATE: 20151211
DATE AS OF CHANGE: 20151211
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: 151282887
MAIL ADDRESS:
STREET 1: 1660 WALT WHITMAN ROAD
STREET 2: SUITE 105
CITY: MELVILLE
STATE: NY
ZIP: 11747
4
1
formfour.xml
X0306
4
2015-12-09
0
0001316645
American CareSource Holdings, Inc.
GNOW
0000897464
PAPPAJOHN JOHN
C/O AMERICAN CARESOURCE HOLDINGS, INC.
1170 PEACHTREE STREET NE, SUITE 2350
ATLANTA
GA
30309
1
1
1
0
Acting Chief Executive Officer
Common Stock, par value $0.01 per share
2015-12-09
4
A
0
2857142
A
5166760
D
Common Stock, par value $0.01 per share
16791
I
By Equity Dynamics, Inc.
Common Stock, par value $0.01 per share
5000
I
By Halkis, Ltd.
Common Stock, par value $0.01 per share
5000
I
By Spouse
Common Stock, par value $0.01 per share
5000
I
By Thebes, Ltd.
Warrant to Purchase Common Stock
0.875
2015-12-09
4
A
0
2857142
A
2015-12-09
2020-12-09
Common Stock
2857142
2857142
D
In connection with a public offering (the "Offering") of American CareSource Holdings, Inc. (the "Issuer"), the Reporting Person acquired 2,857,142 Class A Units (the "Units") for $0.70 per Unit, with each such Unit consisting of one share of the Issuer's common stock, par value $0.01 per share (the "Common Stock"), and a warrant to purchase one share of Common Stock with an exercise price of $0.875 (the "Warrant"). Accordingly, the Reporting Person acquired 2,857,142 shares of Common Stock and a Warrant to purchase 2,857,142 shares of Common Stock in the Offering.
The Reporting Person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.
/s/ John Pappajohn
2015-12-11