Filing Details
- Accession Number:
- 0001654954-23-004640
- Form Type:
- 13G Filing
- Publication Date:
- 2023-04-11 20:00:00
- Filed By:
- Everakes Bruce
- Company:
- Pacific Health Care Organization Inc (OTCMKTS:PFHO)
- Filing Date:
- 2023-04-12
- 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 Sarah Everakes | 702,356 | 7 | 702,356 | 9 | 702,356 | 5.48% |
Filing
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, Par Value $.001 per share |
| (Title
of Class of Securities) |
|
6943P308 |
| (CUSIP
Number) |
|
March 28,2023 |
| (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).
SCHEDULE 13G
|
CUSIP No. | |
|
1 |
Names of Reporting Persons | ||
| Bruce
& Sarah Everakes | |||
|
2 |
Check the appropriate box if a member of a Group (see
instructions) | ||
| (a) [
](b) [ ] | |||
|
3 |
Sec Use Only | ||
| | |||
|
4 |
Citizenship or Place of Organization | ||
| United
States of America | |||
|
Number of Shares Beneficially Owned by Each Reporting Person
With: |
5 | Sole
Voting Power | |
| 702,356 | |||
|
6 | Shared
Voting Power | ||
| | |||
|
7 | Sole
Dispositive Power | ||
| 702,356 | |||
|
8 | Shared
Dispositive Power | ||
| | |||
|
9 |
Aggregate Amount Beneficially Owned by Each Reporting
Person | ||
| 702,356 | |||
|
10 |
Check box if the aggregate amount in row (9) excludes certain
shares (See Instructions) | ||
| [
] | |||
|
11 |
Percent of class represented by amount in row (9) | ||
| 5.48% | |||
|
12 |
Type of Reporting Person (See Instructions) | ||
| IN | |||
Page 2
of 5
Item 1.
(a)
Name
of Issuer: Pacific Health Care Organization Inc.
(b)
Address
of Issuer’s Principal Executive Offices: 19800 MacArthur Blvd
307 Irvine, CA 92612
Item 2.
(a)
Name
of Person Filing: Bruce Everakes
The
securities reported herein are held directly by the reporting
person as well as shares held by family members. The reporting
person makes the voting and investment decisions.
(b)
Address
of Principal Business Office or, if None, Residence: 3442 River
Falls Northbook, IL 60062
(c)
Citizenship: US
(d)
Title
and Class of Securities: Common Shares $.001 par value
(e)
CUSIP
No.: 6943P308
Item
3. N/A
Item
4.
Ownership
(a
Amount Beneficially Owned:
see row 9 of cover page
(b)
Percent
of Class: see row 11 of cover page
(c)
Number
of shares as to which such person has:
(i)
Sole
power to vote or to direct the vote: see row 5 of cover
page
(ii)
Shared
power to vote or to direct the vote: see row 6 of cover
page
(iii)
Sole
power to dispose or to direct the disposition of: see row 7 of
cover page
(iv)
Shared
power to dispose or to direct the disposition of: see row 8 of
cover page
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 [ ].
Item
6.
Ownership
of more than Five Percent on Behalf of Another Person.
N/A
Item
7.
Identification
and classification of the subsidiary which acquired the security
being reported on by the parent holding company or control person.
N/A
Item
8.
Identification
and classification of members of the group. N/A
Item
9.
Notice
of Dissolution of Group. N/A
Item
10.
Certifications.
Page
3 of 5
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:
/s/ Signature Bruce Everakes
Name/Title
The
original statement shall be signed by each person on whose behalf
the statement is filed or his authorized representative. If the
statement is signed on behalf of a person by his authorized
representative (other than an executive officer or general partner
of this filing person), evidence of the representative's authority
to sign on behalf of such person shall be filed with the statement,
provided, however, that a power of attorney for this purpose which
is already on file with the Commission may be incorporated by
reference. The name and any title of each person who signs the
statement shall be typed or printed beneath his
signature.
Attention: Intentional misstatements or omissions of fact
constitute Federal criminal violations (See 18 U.S.C.
1001).
Page
4 of 5
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:
/s/ Signature Bruce Everakes
Name/Title
The
original statement shall be signed by each person on whose behalf
the statement is filed or his authorized representative. If the
statement is signed on behalf of a person by his authorized
representative (other than an executive officer or general partner
of this filing person), evidence of the representative's authority
to sign on behalf of such person shall be filed with the statement,
provided, however, that a power of attorney for this purpose which
is already on file with the Commission may be incorporated by
reference. The name and any title of each person who signs the
statement shall be typed or printed beneath his
signature.
Attention: Intentional misstatements or omissions of fact
constitute Federal criminal violations (See 18 U.S.C.
1001).
Page 5
of 5