Statement of Changes in Beneficial Ownership (4)
October 29 2014 - 10:05AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Dove Foundation
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2. Issuer Name
and
Ticker or Trading Symbol
UNITED AMERICAN HEALTHCARE CORP
[
UAHC
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
C/O JAMES M. DELAHUNT, ESQ., 4783 LAKE VALLEY DRIVE, SUITE 2A
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3. Date of Earliest Transaction
(MM/DD/YYYY)
10/24/2014
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(Street)
LISLE, IL 60532
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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10/24/2014
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10/28/2014
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J
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2000000
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A
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$.0043
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4478647
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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Remarks:
(1) As disclosed in the Reporting Person's Schedule 13D, Amendment No. 2 filed on October 29, 2014, the Issuer issued 2,000,000 shares of its common stock ("Common Stock") to the Reporting Person as a result of the Reporting Person's exercise of a remedy, upon the occurrence of an event of default, to receive shares of Common Stock in lieu of cash, at a price of $.004323 per share, of $8,646.00 of the outstanding balance of that certain Unsecured Promissory Note dated October 10, 2012, attached as Exhibit 1 to the Reporting Person's Schedule 13D, Amendment No. 1 filed on July 9, 2013. The Reporting Person also owns 1,603,647 shares of Common Stock, as reported in the Schedule 13D filed on June 8, 2010 by the Reporting Person, and 875,000 shares of Common Stock, as reported in the Schedule 13D, Amendment No. 1 filed on July 9, 2013 by the Reporting Person.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Dove Foundation
C/O JAMES M. DELAHUNT, ESQ.
4783 LAKE VALLEY DRIVE, SUITE 2A
LISLE, IL 60532
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X
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Signatures
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/s/ James M. Delahunt, Esq., as Trustee
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10/29/2014
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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