0001185185-14-001934.txt : 20140801 0001185185-14-001934.hdr.sgml : 20140801 20140731183718 ACCESSION NUMBER: 0001185185-14-001934 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20140801 DATE AS OF CHANGE: 20140731 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PACIFIC HEALTH CARE ORGANIZATION INC CENTRAL INDEX KEY: 0001138476 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 870285238 STATE OF INCORPORATION: UT FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-78744 FILM NUMBER: 141007559 BUSINESS ADDRESS: STREET 1: 1201 DOVE STREET STREET 2: SUITE 300 CITY: NEWPORT BEACH STATE: CA ZIP: 92260 BUSINESS PHONE: (949) 721-8272 MAIL ADDRESS: STREET 1: 1201 DOVE STREET STREET 2: SUITE 300 CITY: NEWPORT BEACH STATE: CA ZIP: 92260 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: Balzano Donald P CENTRAL INDEX KEY: 0001614439 FILING VALUES: FORM TYPE: SC 13G MAIL ADDRESS: STREET 1: 5422 MICHELLE DRIVE CITY: TORRANCE STATE: CA ZIP: 90503 SC 13G 1 phco-sc13g_balzano073114.htm SC 13G phco-sc13g_balzano073114.htm
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
 
 
SCHEDULE 13G
 
 
Under the Securities Exchange Act of 1934
(Amendment No.)*
 
Pacific Health Care Organization, Inc.
(Name of Issuer)
 
Common Stock, $.001 par value per share
(Title of Class of Securities)
 
69439P209
(CUSIP Number)

December 31, 2002
(Date of Event which Requires Filing of this Statement)

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

o Rule 13d-1(b)

o Rule 13d-1(c)

x Rule 13d-1(d)

* The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
 
 
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CUSIP No. 69439P209

       
 
1.
Names of Reporting Persons
I.R.S. Identification Nos. of above persons (entities only).
 
  
   
Donald P. Balzano
  
       
 
2.
Check the Appropriate Box if a Member of a Group (See Instructions)
  
     
(a)  o
     
(b)  o
       
 
3.
SEC Use Only
  
       
 
4.
Citizenship or Place of Organization
  
   
United States of America
  
Number of
5.
Sole Voting Power
  
Shares
  
54,165
  
Beneficially
6.
Shared Voting Power
  
Owned by
  
-0-
  
Each
7.
Sole Dispositive Power
  
Reporting
  
54,165
  
Person
8.
Shared Dispositive Power
  
With:
  
-0-
  
       
 
9.
Aggregate Amount Beneficially Owned by Each Reporting Person
  
   
54,165(1)
  
       
 
10.
Check if the Aggregate Amount in Row (9) Excludes Certain Shares
(See Instructions)
 
o
       
 
11.
Percent of Class Represented by Amount in Row (9)
  
   
6.8%
  
       
 
12.
Type of Reporting Person (See Instructions)
  
   
IN
  
       
(1)  The percentage reported in this Schedule 13G is based upon 802,424 shares of Common Stock outstanding according to Form 10-Q filed by the Issuer on May 14, 2014.
 
 
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Item 1(a).  Name of Issuer

Pacific Health Care Organization, Inc.

Item 1(b).  Address of Issuer’s Principal Executive Officers

1201 Dove Street, Suite 300
Newport Beach, California 92660

Item 2(a).  Name of Person Filing

Donald P. Balzano

Item 2(b).  Address of Principal Business Office, or if none, Residence

1201 Dove Street, Suite 300
Newport Beach, California 92660

Item 2(c).  Citizenship

United States of America

Item 2(d).  Title of Class of Securities

Common Stock

Item 2(e).  CUSIP Number

69439P209

Item 3.  If this statement is filed pursuant to Sections 240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:

(a)  
o      Broker or dealer registered under Section 15 of the Exchange Act.

(b)  
o      Bank as defined in Section 3(a)(6) of the Exchange Act.

(c)  
o      Insurance company defined in Section 3(a)(19) of the Exchange Act.
 
(d)  
o      Investment company registered under Section 8 of the Investment Company Act.
 
(e)  
o      Investment adviser in accordance with Rule 13d-1(b)(1)(ii)(E).
 
(f)  
o      Employee benefit plan or endowment fund in accordance with Rule 13d-1(b)(1)(ii)(F).
 
 
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(g)  
o      Parent holding company or control person in accordance with Rule 13d-1(b)(1)(ii)(G).
 
(h)  
o      Savings association as defined with Section 3(b) of the Federal Deposit Insurance Act.
 
(i)  
o      Church plan that is excluded from the definition of an investment company under Section 3(c)(14) of the Investment Company Act.
 
(j)  
o      Non-U.S. institution in accordance with Section 240.13d-1(b)(1)(ii)(J).
 
(k)  
o      Group, in accordance with Rule 240.13d-1(b)(1)(ii)(K),  If filing as a non-U.S. institution in accordance with Section 240.13d-1(b)(1)(ii)(J), please specify the type of institution:  _________
 
Item 4.  Ownership

(a)  
Amount beneficially owned:

As of the close of business on July 29, 2014 Mr. Balzano owned 54,165 shares of Common Stock.

(b)  
Percent of class:

As of the close of business on July 29, 2014 Mr. Balzano owned 6.8% of the outstanding shares of Common Stock.  The percentage is based upon 802,424 shares of Common Stock outstanding according to Form 10-Q filed by the Issuer on May 14, 2014.

(c)  
Number of shares  to which the person has:

(i)  
Sole power to vote or direct the vote of Common Stock:

54,165

(ii)  
Shared power to vote or direct the vote of Common Stock:

-0-
 
(iii)  
Sole power to dispose or to direct the power disposition of Common Stock:

54,165

(iv)  
Shared power to dispose or to direct the power disposition of Common Stock:

-0-
 
 
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Item 5.  Ownership of Five Percent or Less of a Class

If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following o.

Item 6.  Ownership of More than Five Percent on Behalf of Another Person

Not applicable.

Item 7.  Identification and Classification of the Subsidiary Which Acquired the Security Being Reporting on by the Parent Holding Company.

Not applicable.

Item 8. Identification and Classification of Members of the Group

Not applicable.

Item 9.  Notice of Dissolution of Group

Not applicable.

Item 10.  Certification

By signing below each of the undersigned certifies that, to the best of his knowledge and belief, the securities referred to above were not acquired and are not held for the purpose or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.
 
 
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SIGNATURES

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
     
     
     
Date: July 30, 2014
By:
/s/ Donald P. Balzano
   
Donald P. Balzano



 
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