0001171843-16-010782.txt : 20160621 0001171843-16-010782.hdr.sgml : 20160621 20160621171113 ACCESSION NUMBER: 0001171843-16-010782 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160620 FILED AS OF DATE: 20160621 DATE AS OF CHANGE: 20160621 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: 55 IVAN ALLEN JR. BLVD STREET 2: SUITE 510 CITY: ATLANTA STATE: GA ZIP: 30308 BUSINESS PHONE: 972-308-6830 MAIL ADDRESS: STREET 1: 55 IVAN ALLEN JR. BLVD STREET 2: SUITE 510 CITY: ATLANTA STATE: GA ZIP: 30308 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: 161724986 MAIL ADDRESS: STREET 1: 1660 WALT WHITMAN ROAD STREET 2: SUITE 105 CITY: MELVILLE STATE: NY ZIP: 11747 4 1 formfour.xml OWNERSHIP DOCUMENT X0306 4 2016-06-20 0 0001316645 American CareSource Holdings, Inc. GNOW 0000897464 PAPPAJOHN JOHN C/O AMERICAN CARESOURCE HOLDINGS, INC. 55 IVAN ALLEN JR. BLVD., SUITE 510 ATLANTA GA 30308 1 0 1 0 Common Stock, par value $0.01 per share 2016-06-20 4 P 0 5383 0.20 A 6127751 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. 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 2016-06-21