-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, JEmuodTLnCY0jTPL5/cNHlAg+/1pBmcsjsA1wBxX5CGZJ15ydrMW7xXVetaLO7NP nEPKJP8U2OrNcJrVKTBCYQ== /in/edgar/work/20000728/0000906337-00-000011/0000906337-00-000011.txt : 20000921 0000906337-00-000011.hdr.sgml : 20000921 ACCESSION NUMBER: 0000906337-00-000011 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000720 FILED AS OF DATE: 20000728 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PROXYMED INC /FT LAUDERDALE/ CENTRAL INDEX KEY: 0000906337 STANDARD INDUSTRIAL CLASSIFICATION: [7374 ] IRS NUMBER: 650202059 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-22052 FILM NUMBER: 680966 BUSINESS ADDRESS: STREET 1: 2555 DAVIE ROAD STREET 2: SUITE 110 CITY: FORT LAUDERDALE STATE: FL ZIP: 33317-7424 BUSINESS PHONE: 9544731001 FORMER COMPANY: FORMER CONFORMED NAME: HMO PHARMACY INC DATE OF NAME CHANGE: 19930601 COMPANY DATA: COMPANY CONFORMED NAME: DRAPKIN DONALD G CENTRAL INDEX KEY: 0001046392 STANDARD INDUSTRIAL CLASSIFICATION: [0000 ]DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: PROXYMED STREET 2: 2555 DAVIE RD STE 110 CITY: FT LAUDERDALE STATE: FL ZIP: 33317 BUSINESS PHONE: 9544731001 MAIL ADDRESS: STREET 1: PROXYMED STREET 2: 2555 DAVIE RD STE 110 CITY: FT LAUDERDALE STATE: FL ZIP: 33317 3 1 0001.txt FORM 3 - 07/20/00 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 1. Name and Address of Reporting Person Drapkin, Donald G Rio Vista Drive P.O. Box 1040 Alpine, NJ 07620 USA 2. Date of Event Requiring Statement (Month/Day/Year) 07/20/00 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Issuer Name and Ticker or Trading Symbol ProxyMed, Inc. PILL 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director ( ) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) Director 6. If Amendment, Date of Original (Month/Day/Year) 7. Individual or Joint/Group Filing (Check Applicable Line) (X) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person
___________________________________________________________________________________________________________________________________ Table I -- Non-Derivative Securities Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1. Title of Security |2. Amount of |3. Ownership |4. Nature of Indirect | | Securities | Form: | Beneficial Ownership | | Beneficially | Direct(D) or | | | Owned | Indirect(I) | | ___________________________________________________________________________________________________________________________________| None | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securitites Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of Derivative |2.Date Exer- |3.Title and Amount | |4. Conver-|5. Owner- |6. Nature of Indirect | Security | cisable and | of Underlying | |sion or |ship | Beneficial Ownership | | Expiration | Securities | |exercise |Form of | | | Date(Month/ |-----------------------|---------|price of |Deriv- | | | Day/Year) | |Amount |deri- |ative | | | Date | Expira- | |or |vative |Security: | | | Exer- | tion | Title |Number of|Security |Direct(D) or | | | cisable | Date | |Shares | |Indirect(I) | | ___________________________________________________________________________________________________________________________________| Series C 7% Convertible |N/A* |N/A |Preferred convertible i|100,000 |$1.00 |D | | Preferred Stock | | |nto Common w/optional &| | | | | | | | Mandatory conversion r| | | | | | | |ights | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |07/07/01*|06/28/05 |Common Stock, par value|50,000 |$1.00** |D | | | | | $.001 | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________|
Explanation of Responses: *Conversion and Warrant Shares are subject to a 12-month lockup, which may be extended an additional 12 months at the discretion of the Placement Agent. **Subject to anti-dilution adjustments as provided in the Warrant Agreement. SIGNATURE OF REPORTING PERSON Donald G. Drapkin DATE July 28, 2000 -----END PRIVACY-ENHANCED MESSAGE-----