-----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, DY5KGRZj72ilszK8eQTd0BzJG4vslAevp3Gq6DLP042GvARRgdkhJKmvrHN56TdU ePpZlA2urGm/zrN+Uj7l3g== /in/edgar/work/20000731/0000906337-00-000013/0000906337-00-000013.txt : 20000921 0000906337-00-000013.hdr.sgml : 20000921 ACCESSION NUMBER: 0000906337-00-000013 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000720 FILED AS OF DATE: 20000731 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: 682686 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: FALK MICHAEL S CENTRAL INDEX KEY: 0001023981 STANDARD INDUSTRIAL CLASSIFICATION: [ ]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 Falk, Michael S One Beekman Place, #15A New York, NY 10022 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) | | ___________________________________________________________________________________________________________________________________| Common Stock, par value $.001 per share(1) |22,666 |I |CommonWealth Associates | - -----------------------------------------------------------------------------------------------------------------------------------| Common Stock, par value $.001 per share |62,600 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ 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) | | ___________________________________________________________________________________________________________________________________| Warrants |immed |06/07/05 |Common Stock |1,000,000|$1.00 |I |See Footnote (1) | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |immed |05/07/05 |Common Stock |1,000,000|$1.50 |I |See Footnote (1) | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |immed |06/29/05 |Common Stock |5,325,366|$1.00 |I |See Footnote (1) | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |immed |05/07/01 |Common Stock |98,000 |$5.63 |I |See Footnote (1) | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |immed |06/01/03 |Common Stock |47,188 |$12.10 |I |See Footnote (1) | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |immed |01/21/04 |Common Stock |10,000 |$11.44 |I |See Footnote (1) | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |immed |06/10/04 |Common Stock |35,000 |$13.31 |I |See Footnote (1) | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |immed |06/10/04 |Common Stock |7,333 |$10.00 |I |See Footnote (1) | - -----------------------------------------------------------------------------------------------------------------------------------| Series C 7% Convertible |N/A |N/A |Common Stock |150,000 |$1.00 |I |See Footnote (2) | Preferred Stock | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |immed |06/29/05 |Common Stock |75,000 |$1.00 |I |See Footnote (2) | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________|
Explanation of Responses: (1) There shares and warrants are owned directly by Commonwealth Associates, L.P. ("Commonwealth"). Reporting Person is Chairman and principal stockholder of Commonwealth Associates Management Corp. ("CAMC"), the general partner of Commonwealth. Reporting person disclaims beneficial ownership of the shares and warrants held by Commonwealth other than that portion which corresponds with his equity ownership in CAMC. (2) These securities are owned directly by ComVest Capital Partners LLC ("ComVest"). Reporting person is a Manager and principal member of ComVest. Reporting person disclsims beneficial ownership of the securities held by ComVest other than that portion which corresponds with his membership interest in ComVest. SIGNATURE OF REPORTING PERSON Michael S. Falk DATE July 31, 2000 -----END PRIVACY-ENHANCED MESSAGE-----