Filing Details
- Accession Number:
- 0001654954-19-001591
- Form Type:
- 13G Filing
- Publication Date:
- 2019-02-14 19:32:59
- Filed By:
- Everakes Bruce
- Company:
- Pacific Health Care Organization Inc (OTCMKTS:PFHO)
- Filing Date:
- 2019-02-15
- SEC Url:
- 13G Filing
Ownership Summary
Please notice the below summary table is generated without human intervention and may contain errors. Please refer to the complete filing displayed below for exact figures.
| Name | Sole Voting Power | Shared Voting Power | Sole Dispositive Power | Shared Dispositive Power | Aggregate Amount Owned Power | Percent of Class |
|---|---|---|---|---|---|---|
| Bruce Everakes | 8. | 172 | 5.39 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 6943P308 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) Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o) (b) Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c) (c) Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c) (d) Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C 80a-8) (e) An investment adviser in accordance with 240.13d-1(b)(1)(ii)(E) (f) An employee benefit plan or endowment fund in accordance with 240.13d-1(b)(1)(ii)(F) (g) A parent holding company or control person in accordance with 240.13d-1(b)(1)(ii)(G) (h) A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813) (i) 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) A non-U.S. institution, in accordance with 240.13d-1(b)(1)(ii)(J) (k) 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% |
Filing
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) | |
| | | |
| | 6943P308 | |
| | (CUSIP
Number) | |
| | | |
| | February
14, 2019 | |
| | (Date
of Event Which Requires Filing of this Statement) | |
Check
the appropriate box to designate the rule pursuant to which this
Schedule is filed
| ☐ | Rule
13d-1(b) |
| ☐ | Rule
13d-1(c) |
| ☐ | 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. 6943P308
| 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)
☐ (b)
☐ | |
| 3. | SEC Use
Only | |
| 4. | Citizenship of
Place of Organization United
States of America | |
| | 5. | Sole
Voting Power New
139062 |
| 6. | Shared
Voting Power New
7064 | |
| 7. | Sole
Dispositive Power | |
| 8. | Shared
Dispositive Power New
26588 | |
| 9. | Aggregate Amount
Beneficially Owned by each Reporting Person 172714 | |
| 10. | Check
if the Aggregate Amount in Row (9) Excludes Certain Shares
☐ | |
| 11 | Percent
of Class Represented by Amount in Row 9 5.39 | |
| 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:
6943P308
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) | ☐ | Broker
or dealer registered under section 15 of the Act (15 U.S.C.
78o); |
| | | | |
| | (b) | ☐ | Bank
as defined in section 3(a)(6) of the Act (15 U.S.C.
78c); |
| | | | |
| | (c) | ☐ | Insurance
company as defined in section 3(a)(19) of the Act (15 U.S.C.
78c); |
| | | | |
| | (d) | ☐ | Investment
company registered under section 8 of the Investment Company Act of
1940 (15 U.S.C 80a-8); |
| | | | |
| | (e) | ☐ | An
investment adviser in accordance with
§240.13d-1(b)(1)(ii)(E); |
| | | | |
| | (f) | ☐ | An
employee benefit plan or endowment fund in accordance with
§240.13d-1(b)(1)(ii)(F); |
| | | | |
| | (g) | ☐ | A
parent holding company or control person in accordance with §
240.13d-1(b)(1)(ii)(G); |
| | | | |
| | (h) | ☐ | A
savings associations as defined in Section 3(b) of the Federal
Deposit Insurance Act (12 U.S.C. 1813); |
| | | | |
| | (i) | ☐ | 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) | ☐ | A
non-U.S. institution, in accordance with
§240.13d-1(b)(1)(ii)(J); |
| | | | |
| | (k) | ☐ | 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 | | |
| | (ii) | Shared
power to vote or to direct the vote | | |
| | (iii) | Sole
power to dispose or to direct the disposition of | | |
| | (iv) | Shared power to dispose or to direct the disposition of | | |
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:
2/14/2019 | By: | /s/
Bruce Everakes | |
| | | Bruce
Everakes | |
| | | | |