SEC Form 4 · accession 0001171843-15-006768

American CareSource Holdings, Inc. · GNOW

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — Acting Chief Executive Officer · Director · 10% Owner

Period of report

Dec 9, 2015

Accepted (ET)

Dec 11, 2015 · 2:11 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001316645

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock, par value $0.01 per share^F1	Dec 9, 2015	A	2,857,142	—	A	5,166,760	D
Common Stock, par value $0.01 per share	holding	—	—		—	16,791	I	By Equity Dynamics, Inc.
Common Stock, par value $0.01 per share	holding	—	—		—	5,000	I	By Halkis, Ltd.
Common Stock, par value $0.01 per share^F2	holding	—	—		—	5,000	I	By Spouse
Common Stock, par value $0.01 per share^F2	holding	—	—		—	5,000	I	By Thebes, Ltd.

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Warrant to Purchase Common Stock^F1	$0.875	Dec 9, 2015	A	2,857,142	A	Dec 9, 2015	Dec 9, 2020	Common Stock	2,857,142	2,857,142	D

F1In connection with a public offering (the "Offering") of American CareSource Holdings, Inc. (the "Issuer"), the Reporting Person acquired 2,857,142 Class A Units (the "Units") for $0.70 per Unit, with each such Unit consisting of one share of the Issuer's common stock, par value $0.01 per share (the "Common Stock"), and a warrant to purchase one share of Common Stock with an exercise price of $0.875 (the "Warrant"). Accordingly, the Reporting Person acquired 2,857,142 shares of Common Stock and a Warrant to purchase 2,857,142 shares of Common Stock in the Offering.
F2The 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.