FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 09/05/2007 |
3. Issuer Name and Ticker or Trading Symbol
Integrated Healthcare Holdings Inc [ IHCH.OB ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 9,748,498 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Warrant to Purchase Common Stock | 01/31/2007 | 07/31/2008 | Common Stock | (1) | (2) | D |
Explanation of Responses: |
1. The Warrant is exercisable for such number of shares of common stock of the Company that would not exceed, when added to the number of shares of common stock previously acquired upon exercise of the Warrant, 4.9% of the total number of outstanding shares of the Company on a fully-diluted basis on the date of exercise, up to a maximum of 14,700,000 shares. The 9,748,498 shares currently held by the filing person, as indicated on Table I above, were acquired upon exercise of the Warrant. Therefore, until the expiration date, the Warrant remains exercisable for 4.9% of the fully-diluted shares of the Company to the extent such amount is more than 9,748,498 shares, up to a maximum of 14,700,000 shares. A copy of the Warrant has been filed as Exhibit B-2 to Exhibit 99.1 of the Company's Current Report on Form 8-K filed on February 2, 2005. |
2. The exercise price of the first 8,4617,847 shares of common stock purchased upon exercise of the Warrant is $0.003125 per share, and the exercise price for the remainder of the shares is $0.078 per share if exercised between January 31, 2007 and July 30, 2007, $0.11 per share if exercised between July 31, 2007 and January 30, 2008, and $0.15 thereafter, all subject to certain antidilution adjustments set forth in the Warrant. |
Remarks: |
/s/ William E. Thomas | 09/17/2007 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |