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OMB APPROVAL
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OMB Number 3235-0104
Expires: Sept 30, 1998
Estimated average burden
hours per response ....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Wingate Financial Associates, LLC
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(Last) (First) (Middle)
210 Darmouth
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(Street)
Pawtucket Rhode Island 02860
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
March 19, 1997
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
American HealthChoice, Inc. AHIC
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5 Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [ ] 10% Owner
[ ] Officer (give title below) [ X ] Other (specify below)
Investor (Beneficial owner of 10% at Date of Event)
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6. If Amendment, Date of Original (Month/Day/Year)
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7. Individual or Joint/Group Filing (Check applicable line)
(Month/Day/Year)
[ X ] Form filed by One Reporting Person
[ ] Form filed by More than One Reporting Person
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Table I -- Non-Derivative Securities Beneficially Owned
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr.5)
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<S> <C> <C> <C>
N/A
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
<PAGE>
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Security Exer- tion of Derivative (I) Ownership
(Instr. 4) cisable Date Title Shares Security (Instr.5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
Warrants 3/20/97(1) 4/1/98 Common Stock, $.001 1,000,000 $2.375 (D)
par value
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Options 4/18/97(1) 9/19/98 Common Stock, $.001 2,000,000 $2.75 (D)
par value
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</TABLE>
Explanation of Responses:
(1) See discussion on Page 3 with respect to issuance of warrants and Options
identified in Table II above.
By: /s/ Mandel Sherman July 16, 1997
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Manager of Wingate Financial Associates, LLC Date
**Signature of Reporting Person
** Intentional misstatements or omissions of facts constitute Federal Criminal
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space provided is insufficient, See Instruction 6 for procedure.
<PAGE>
Additional Information
FORM 3 (continued)
1. Reporting Person: Wingate Financial Associates, LLC
210 Darmouth
Pawtucket, RI 02860
2. Date of Event: March 19, 1997
4. Issuer: American HealthChoice, Inc. (AHIC)
Explanation of Response (continued):
The warrants were granted to the Reporting Person in partial consideration of
assisting the Issuer in its capital raising efforts as well as a $550,000 loan
to such Issuer (collectively, the "Transaction"). Such warrants entitle the
Reporting Person to purchase up to 1,000,000 shares of Common Stock of the
Issuer any time after March 20, 1997 and before April 1, 1998, at an exercise
price of $2.375 per share.
The options were granted to the Reporting Person by certain existing
stockholders of the Issuer as a further inducement to the Reporting Person to
enter into the Transaction. Such options entitle the Reporting Person to
purchase up to an aggregate of 2,000,000 additional shares of Common Stock of
the Issuer (the "Option Shares"), at an exercise price of $2.75 per share, as
follows: (i) an option to purchase up to 300,000 Option Shares, commencing April
18, 1997, in the event that the Company's Common Stock trades at $5.00 for 5
consecutive trading days; (ii) an option to purchase up to an additional 300,000
Option Shares commencing June 17, 1997, in the event that the Company's Common
Stock trades at $5.50 for 5 consecutive trading days; (iii) an option to
purchase up to an additional 300,000 Option Shares, commencing July 17, 1997, in
the event that the Company's Common Stock trades at $6.00 for 5 Consecutive
trading days; (iv) an option to purchase up to an additional 300,000 Option
Shares, commencing September 15, 1997, in the event that the Company's Common
Stock trades at $6.50 for 5 consecutive trading days; (v) an option to purchase
up to an additional 300,000 Option Shares, commencing November 14, 1997, in the
event that the Company's Common Stock trades at $7.00 for 5 consecutive trading
days; and (vi) an option to purchase up to an additional 500,000 Option Shares,
commencing January 13, 1998, in the event that the Company's Common Stock trades
at $7.00 for 5 consecutive trading days.
