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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 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*
Commonwealth Associates L.P.
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(Last) (First) (Middle)
830 Third Avenue
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(Street)
New York, New York 10022
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
June 29, 2000
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3. IRS Identification Number of Reporting Person, if an entity (Voluntary)
13-3467952
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4. Issuer Name and Ticker or Trading Symbol
ProxyMed, Inc. (Nasdaq National Market: PILL)
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
|X| Director |X| 10% Owner
|_| Officer (give title below) |_| Other (specify below)
Michael S. Falk is a director
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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)
|_| Form filed by One Reporting Person
|X| 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>
Common Stock, par value $.001 per share(1) 22,666 D
Common Stock, par value $.001 per share 62,500 I (2)
Common Stock, par value $.001 per share 52,958 I (3)
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</TABLE>
* If the Form is filed by more than one Reporting Person see instruction
5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
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FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
<TABLE>
<CAPTION>
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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 Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
Warrants to purchase Common Stock immed. 06/07/05 Common Stock 1,000,000 $1.00 D
Warrants to purchase Common Stock immed 05/07/05 Common Stock 1,000,000 $1.50 D
Warrants to purchase Common Stock immed 06/29/05 Common Stock 5,325,366 $1.00 D
Warrants to purchase Common Stock immed 05/07/01 Common Stock 98,000 $5.63 D
Warrants to purchase Common Stock immed 06/01/03 Common Stock 47,188 $12.10 D
Warrants to purchase Common Stock immed 01/21/04 Common Stock 10,000 $11.44 D
Warrants to purchase Common Stock immed 06/10/04 Common Stock 35,000 $13.31 D
Warrants to purchase Common Stock immed 06/10/04 Common Stock 7,333 $10.00 D
Warrants to purchase Common Stock immed 06/29/05 Common Stock 75,000 $1.00 I (4)
Series C Convertible Preferred Stock n/a n/a Common Stock 150,000 $1.00 I (4)
Warrants to purchase Common Stock immed 06/29/05 Common Stock 50,000 $1.00 I (2)
Series C Convertible Preferred Stock n/a n/a Common Stock 100,000 $1.00 I (2)
Warrants to purchase Common Stock immed 06/29/05 Common Stock 2,180,145 $1.00 I (2)
Warrants to purchase Common Stock immed 06/10/04 Common Stock 5,500 $10.00 I (2)
Warrants to purchase Common Stock immed 05/07/01 Common Stock 54,000 $5.63 I (2)
Warrants to purchase Common Stock immed 06/10/04 Common Stock 20,341 $12.10 I (2)
Warrants to purchase Common Stock immed 06/29/05 Common Stock 1,250,000 $1.00 I (5)
Series C Convertible Preferred Stock n/a n/a Common Stock 2,500,000 $1.00 I (5)
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</TABLE>
Explanation of Responses: See attached footnotes.
Commonwealth Associates L.P.
By: Commonwealth Associates Management Corp., its general partner
/s/ Joseph Wynne August 8, 2000
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** Signature of Reporting Person Date
Joseph Wynne
Chief Financial Officer
** 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.
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FOOTNOTES
(1) These shares and warrants are owned directly by Commonwealth Associates L.P
("Commonwealth"). Michael S. Falk ("Falk") and Robert Priddy ("Priddy") are
directors and shareholders of Commonwealth Associates Management Corp., the
general partner of Commonwealth ("CAMC"). Falk is the Chairman and principal
stockholder of CAMC. Falk and Priddy disclaim beneficial ownership of the shares
and warrants held by Commonwealth other than that portion which corresponds with
their respective equity ownership in CAMC.
(2) These shares and warrants are owned directly by Falk.
(3) These shares and warrants are owned directly by Priddy.
(4) These securities are owned directly by ComVest Capital Partners LLC
("ComVest"). Falk and Priddy are Managers and members of ComVest, and Falk is
the principal member of ComVest. Falk and Priddy disclaim beneficial ownership
of the securities held by ComVest other than that portion which corresponds with
their respective membership interests in ComVest.
(5) These securities are owned directly by RMC Capital, LLC ("RMC"). Priddy is a
principal of RMC and disclaims beneficial ownership of the securities held by
RMC other than that portion which corresponds with his membership interests
therein.
<PAGE>
JOINT FILER INFORMATION AND AUTHORIZATION
Name: Commonwealth Associates Management Corp.
830 Third Avenue
New York, New York 10022
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: ProxyMed, Inc. (PILL)
Statement Date: June 29, 2000
Signature: By: /s/ Joseph Wynne
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Joseph Wynne, Chief Financial Officer
Name: Michael S. Falk
830 Third Avenue
New York, New York 10022
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: ProxyMed, Inc. (PILL)
Statement Date: June 29, 2000
Signature: /s/ Michael S. Falk
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Michael S. Falk
Name: Robert Priddy
RMC Capital, LLC
1640 Powers Ferry, Suite 125
Marietta, Georgia 30067
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: ProxyMed, Inc. (PILL)
Statement Date: June 29, 2000
Signature: /s/ Robert Priddy
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Robert Priddy
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<PAGE>
Name: RMC Capital, LLC
1640 Powers Ferry, Suite 125
Marietta, Georgia 30067
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: ProxyMed, Inc. (PILL)
Statement Date: June 29, 2000
Signature: /s/ Robert Priddy
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Robert Priddy
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