SEC Form 4 · accession 0001185185-16-005427
PACIFIC HEALTH CARE ORGANIZATION INC · PFHO
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Tom Kubota
Officer — CEO & President · Director
Period of report
Sep 13, 2016
Accepted (ET)
Sep 13, 2016 · 6:56 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001138476
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| CommonF1,F2 | Sep 13, 2016 | P | 1,000 | $9.00 | A | 482,000 | D |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1750 shares of common stock held by the Reporting Person are held pursuant to a restricted stock grant awarded on December 31, 2015. These shares are subject to a one-year vesting period except upon the occurrence of certain events, in which case the restricted stock grant vests immediately. While the Reporting Person is entitled to vote the shares and participate in cash dividends during the restricted period between the date of grant and vesting, the Reporting Person is not entitled to sell, transfer, assign, pledge or otherwise dispose of or encumber the shares until they vest. These shares will be deemed outstanding, but will be held in escrow by the Issuer until they vest. Should the Reporting Person's employment with the Issuer terminate prior to vesting, the shares will be forfeited back to the Issuer.
- F2The Reporting Person holds the shares through the Tom Kubota Revocable Trust of 2013 (the "Trust"). The Reporting Person is the sole Trustee of the Trust. As such, the Reporting Person may be deemed to have voting and/or investment power over the shares held by the Trust and therefore may be deemed to be the beneficial owner of those shares.