-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, SkChG1xWZ6p7CAKgd5dHuqQAZULYQxwhYTk6WgGTnfbpmv3TSj95jrbiYWFp6nqk j5ifIQaEBCz1gii7W5oIEA== 0000898432-05-000407.txt : 20050509 0000898432-05-000407.hdr.sgml : 20050509 20050509170634 ACCESSION NUMBER: 0000898432-05-000407 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050509 FILED AS OF DATE: 20050509 DATE AS OF CHANGE: 20050509 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KIMBERLIN KEVIN CENTRAL INDEX KEY: 0000904841 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32203 FILM NUMBER: 05812613 BUSINESS ADDRESS: STREET 1: SPENCER TRASK SECURITIES INC STREET 2: 535 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2123555565 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PROSPECT MEDICAL HOLDINGS INC CENTRAL INDEX KEY: 0001063561 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-OFFICES & CLINICS OF DOCTORS OF MEDICINE [8011] IRS NUMBER: 330604264 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: 6083 BRISTOL PARKWAY STREET 2: SUITE 100 CITY: CULVER CITY STATE: CA ZIP: 90230 BUSINESS PHONE: 310-338-8677 MAIL ADDRESS: STREET 1: 6083 BRISTOL PARKWAY STREET 2: SUITE 100 CITY: CULVER CITY STATE: CA ZIP: 90230 3 1 kimberlin-prospect_ex.xml X0202 3 2005-05-09 0 0001063561 PROSPECT MEDICAL HOLDINGS INC PZZ 0000904841 KIMBERLIN KEVIN 535 MADISON AVENUE 18TH FLOOR NEW YORK NY 10022 0 0 1 0 Common Stock 66667 I See Note Warrants 1.00 2003-09-19 2010-09-19 Common Stock 372939 I See Note Series A Preferred Stock 5.50 Common Stock 205454 I See Notes Warrants 5.50 2004-01-15 2014-01-15 Series A Preferred Stock 89919 I See Note Reflects holdings of Spencer Trask Investment Partners, LLC ("STIP"), a Delaware limited liability company, of which the Reporting Person is the non-member manager. Currently exercisable; no expiration date. According to the Issuer's Amendment 5 to Form 10 filed 04/07/05, each holder of Series A Preferred Stock may convert the shares of Series A Preferred Stock into shares of the Issuer's Common Stock at any time based upon a conversion ratio equal to the $5.50 per share purchase price of the Series A Preferred Stock divided by the conversion price in effect at the time of conversion. The conversion price is currently $5.50 per share, thereby making the initial conversion ratio one share of Common Stock for each share of Series A Preferred Stock. Includes 81,818 shares held by Spencer Trask Private Equity Fund I LP ("Fund"); 40,909 shares held by Spencer Trask Private Equity Fund II LP ("Fund II"); 51,818 shares held by Spencr Trask Private Eqity Accredited Fund III LLC ("Fund III"); and 30,909 shares held by Spencer Trask Illumination Fund LLC ("Illumination Fund"). The general partner of each of Fund I and Fund II is Trask Partners LLC, a Delaware limited liability company, which is 100%-owned by Spencer Trask & Co., Inc. ("ST&Co."), a Delaware corporation, of which the Reporting Person is the controlling stockholder. The manager of Fund III is Spencer Trask Private Equity Accredited Management Fund III LLC, a Delaware limited liability company, which is owned by ST&Co. The manager of the Illumination Fund is LLC Management Services Inc., a Delaware corporation, which is owned by ST&Co. The Reporting Person disclaims beneficial ownership of the securities reported herein except to the extent of his pecuniary interest therein. Reflects holdings of Spencer Trask Ventures, Inc. ("STVI"), a Delaware corporation and wholly-owned subsidiary of ST&Co. Upon exercise of these warrants and issuance of the underlying 89,919 shares of Series A Preferred Stock, such 89,919 shares of Series A Preferred Stock would be immediately convertible into shares of Common Stock in accordance with the terms described in Note 3 hereof. /s/ Kevin B. Kimberlin 2005-05-09 -----END PRIVACY-ENHANCED MESSAGE-----