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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Convertible Promissory Note | $ 0.2011 | 05/18/2011 | A | 400,000 (3) | 05/18/2011 | 08/17/2012 | Common Stock | 1,988,862 (3) | $ 400,000 | 400,000 (3) | I | See footnote (4) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Fife John M. 303 EAST WACKER DRIVE SUITE 1200 CHICAGO, IL 60601 |
X | X | See Remarks |
/s/ John M. Fife | 05/20/2011 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | John M. Fife owns a controlling interest in, and has investment control over the portfolio of, Chicago Venture Partners, L.P., an Illinois limited partnership, which directly owns 1,068,559 shares of Common Stock of United American Healthcare Corporation, as disclosed in Amendment No. 9 to the Schedule 13D filed by John M. Fife on November 16, 2010, and the Initial Statement of Beneficial Ownership of Securities on Form 3 filed by Chicago Venture Partners, L.P. on August 30, 2010. |
(2) | John M. Fife owns a controlling interest in, and has investment control over the portfolio of, St. George Investments, LLC, an Illinois limited liability company, which directly owns 278,936 shares of Common Stock of United American Healthcare Corporation, as disclosed in Amendment No. 9 to the Schedule 13D filed by John M. Fife on November 16, 2010 and the Statement of Changes in Beneficial Ownership on Form 4 filed by St. George Investments, LLC on June 8, 2010. |
(3) | If the principal amount of the Convertible Promissory Note and the accrued interest thereon were converted in full immediately before maturity (i.e., after all interest has accrued), then the $50,082 in accrued interest would also convert at the conversion price of $0.20112 per share into 249,016 shares of Common Stock of United American Healthcare Corporation, in addition to the 1,988,862 shares issuable upon conversion of the $400,000 principal amount. |
(4) | United American Healthcare Corporation issued the Convertible Promissory Note to St. George Investments, LLC, whose sole member is John M. Fife. |
Remarks: Chairman of the Board, President and Chief Executive Officer |