0001316645-14-000062.txt : 20141208 0001316645-14-000062.hdr.sgml : 20141208 20141208202327 ACCESSION NUMBER: 0001316645-14-000062 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141204 FILED AS OF DATE: 20141208 DATE AS OF CHANGE: 20141208 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: 141273667 MAIL ADDRESS: STREET 1: 1660 WALT WHITMAN ROAD STREET 2: SUITE 105 CITY: MELVILLE STATE: NY ZIP: 11747 4 1 wf-form4_141808819711788.xml FORM 4 X0306 4 2014-12-04 0 0001316645 American Caresource Holdings, Inc. ANCI 0000897464 PAPPAJOHN JOHN C/O AMERICAN CARESOURCE HOLDINGS, INC. 5429 LYNDON B JOHNSON FREEWAY, SUITE 850 DALLAS TX 75240 1 0 0 0 Warrant to Purchase Common Stock 2.71 2014-12-04 4 A 0 480000 A 2014-12-04 2019-12-04 Common Stock 480000.0 480000 D Issued in consideration for providing a guarantee to a lender of up to $3 million for a line of credit rendered to the company. /s/ John Pappajohn 2014-12-08