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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	Yes	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	2022-01-06	8,000	$0.99	8,007,000	No	4	P	Direct

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

Reported Derivative Holdings

Sec. Name	Sec. Type	Price	Date	Expiration Date	Amount	Remaning Holdings	Nature of Ownership
Common Stock	Series A Preferred	$0.00			16,000	16,000	Direct

Expiration Date	Amount	Remaning Holdings	Nature of Ownership
	16,000	16,000	Direct

Footnotes

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.
The Series A Preferred Stock converts into Common Stock of the Issuer on a 1:1 basis at any time at the election of the Reporting Person and has no expiration date.