0001193805-11-002421.txt : 20111222 0001193805-11-002421.hdr.sgml : 20111222 20111222184027 ACCESSION NUMBER: 0001193805-11-002421 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111221 FILED AS OF DATE: 20111222 DATE AS OF CHANGE: 20111222 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: 5429 LYNDON B. JOHNSON FREEWAY STREET 2: SUITE 700 CITY: DALLAS STATE: TX ZIP: 75240 BUSINESS PHONE: 972-308-6830 MAIL ADDRESS: STREET 1: 5429 LYNDON B. JOHNSON FREEWAY STREET 2: SUITE 700 CITY: DALLAS STATE: TX ZIP: 75240 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: 111278653 MAIL ADDRESS: STREET 1: 1660 WALT WHITMAN ROAD STREET 2: SUITE 105 CITY: MELVILLE STATE: NY ZIP: 11747 4 1 e609180_ex.xml X0304 4 2011-12-21 0 0001316645 American Caresource Holdings, Inc. ANCI 0000897464 PAPPAJOHN JOHN C/O AMERICAN CARESOURCE HOLDINGS, INC. 5429 LYNDON B JOHNSON FREEWAY DALLAS TX 75240 1 0 0 0 Common Stock, $0.01 par value per share 2011-12-21 4 P 0 35000 .43 A 5047059 D Common Stock, $0.01 par value per share 65375 I See Footnote Common Stock, $0.01 par value per share 30000 I See Footnote Includes 3,333 restricted stock units, not all of which have vested. Held by entities solely owned by the Reporting Person. Held by Reporting Person's spouse and entity solely owned by Reporting Peron's spouse. /s/ John Pappajohn 2011-12-22