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Filing Details

Issuer

Cik	Name	Symbol	Sector (SIC)	IRS No
1138476	Pacific Health Care Organization Inc	PFHO	Services-Misc Health & Allied Services, Nec (8090)	870285238

Insiders

Cik	Name	Reported Address	Insider Title	Director	Officer	Large Shareholder	Other
1271519	Tom Kubota	2618 San Miguel Drive, #477 Newport Beach CA 92660	Ceo & President	Yes	Yes	No	No

Reported Non-Derivative Transactions

Sec. Name	Acquisiton - Disposition	Date	Amount	Price	Remaning Holdings	Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
Common	Acquisiton	2016-09-13	1,000	$9.00	482,000	No	4	P	Direct

Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
No	4	P	Direct

Footnotes

750 shares of common stock held by the Reporting Person are held pursuant to a restricted stock grant awarded on December 31, 2015. These shares are subject to a one-year vesting period except upon the occurrence of certain events, in which case the restricted stock grant vests immediately. While the Reporting Person is entitled to vote the shares and participate in cash dividends during the restricted period between the date of grant and vesting, the Reporting Person is not entitled to sell, transfer, assign, pledge or otherwise dispose of or encumber the shares until they vest. These shares will be deemed outstanding, but will be held in escrow by the Issuer until they vest. Should the Reporting Person's employment with the Issuer terminate prior to vesting, the shares will be forfeited back to the Issuer.
The Reporting Person holds the shares through the Tom Kubota Revocable Trust of 2013 (the "Trust"). The Reporting Person is the sole Trustee of the Trust. As such, the Reporting Person may be deemed to have voting and/or investment power over the shares held by the Trust and therefore may be deemed to be the beneficial owner of those shares.