0001354488-15-004476.txt : 20151002 0001354488-15-004476.hdr.sgml : 20151002 20151001183921 ACCESSION NUMBER: 0001354488-15-004476 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20151002 DATE AS OF CHANGE: 20151001 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: 151138144 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: everakes bruce CENTRAL INDEX KEY: 0001654501 FILING VALUES: FORM TYPE: SC 13G MAIL ADDRESS: STREET 1: 3442 RIVERFALLS CITY: NORTHBROOK STATE: IL ZIP: 60062 SC 13G 1 pfho_sc13g.htm pfho_sc13g.htm
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

SCHEDULE 13G
(Amendment No. )

Under the Securities Exchange Act of 1934
 
 
Pacific Health Care Organization, Inc.
  
 
(Name of Issuer)
  
     
 
Common Stock, Par Value $.001 per share
  
 
(Title of Class of Securities)
  
     
 
69439P209
  
 
(CUSIP Number)
  
     
 
October 1, 2015
  
 
(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)
o 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).
 
 
 
 
CUSIP No.
1.
Names of Reporting Persons.
I.R.S. Identification Nos. of above persons (entities only).
Bruce Everakes
2.
Check the Appropriate Box if a Member of a Group (See Instructions)
 
(a)  o
(b)  o
3.
SEC Use Only
 
4.
Citizenship of Place of Organization
United States of America
Number of Shares
Beneficially
Owned by Each
Reporting  Person
With
 5.
Sole Voting Power 
33030
6.
Shared Voting Power
440
7. 
Sole Dispositive Power 
 
8.
Shared Dispositive Power
6631
9.
Aggregate Amount Beneficially Owned by each Reporting Person
40101
10.
Check if the Aggregate Amount in Row (9) Excludes Certain Shares  o
 
11.
Percent of Class Represented by Amount in Row 9
5.03%
12.
Type of Reporting Person (See Instructions)
 IN
 
 
 
 
 
ITEM 1:
 
(a)  Name of Issuer:
 
Pacific Health Care Organization, Inc.
 
 (b)  Address of Issur’s Principal Executive Offices:
 
1201 Dove Street
Newport Beach, CA  92660
 
ITEM 2:
 
(a)  Name of Person Filing:
 
Bruce Everakes/Sarah Everakes
 
(b)  Address of Principal Business Office or, if None, Residence:
 
3442 Riverfalls Northbrook, IL  60062

(c)  Citizenship:
 
 United States
 
(d)  Title of Class of Securities:
 
 Common
 
(e)  CUSIP Number:
 
 69439P209
 
 
 
 
 
ITEM 3:  IF THIS STATEMENT IS FILED PURSUANT TO §§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 Act (15 U.S.C. 78o);
       
 
(b) 
 o
 Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c);
       
 
(c) 
 o
 Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c);
       
 
(d) 
 o
 Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C 80a-8);
       
 
(e) 
 o
 An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E);
       
 
(f) 
 o
 An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F);
       
 
(g) 
 o
 A parent holding company or control person in accordance with § 240.13d-1(b)(1)(ii)(G);
       
 
(h) 
 o
 A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);
       
 
(i) 
 o
 A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3);
       
 
(j) 
 o
 A non-U.S. institution, in accordance with §240.13d-1(b)(1)(ii)(J);
       
 
(k) 
 o
 Group, in accordance with §240.13d-1(b)(1)(ii)(K).
   
 
 
 If filing as a non-U.S. institution in accordance with §240.13d-1(b)(1)(ii)(J), please specify the type of institution: ___________________________.
 
ITEM 4:  OWNERSHIP.

(a)  Amount beneficially owned:
 
Bruce Everakes has power over 33,030 shares, Sarah Everakes has power over 6,631 shares and 440 are held jointly
 
(b)  Percent of class:
 
5.03%
 
(c)  Number of shares as to which the person has:
 
                     (i)    Sole power to vote or to direct the vote
33030
  
  (ii)    Shared power to vote or to direct the vote
440
  
  (iii)    Sole power to dispose or to direct the disposition of    
  (iv)    Shared power to dispose or to direct the disposition of   
6631
  
 
ITEM 5:   OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS.
 
NA
 
ITEM 6:   OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON.
 
NA
 
ITEM 7:   IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY.
 
NA
 
ITEM 8:   IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP.
 
NA
 
ITEM 9:   NOTICE OF DISSOLUTION OF GROUP.
 
NA
 
ITEM 10:  CERTIFICATIONS.
 
 
 
 
 
SIGNATURE

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.
 
     
       
Dated: October 1, 2015
By:
/s/ Bruce Everakes
  
    Bruce Everakes