# EDGAR Filing Document

**Accession Number:** 0001138476
**File Stem:** 0001185185-26-002302
**Filing Date:** 2026-6
**Character Count:** 10764
**Document Hash:** 005cf8e7261c98b5a3862476ed435583
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001185185-26-002302.hdr.sgml**: 20260602

**ACCESSION NUMBER**: 0001185185-26-002302

**CONFORMED SUBMISSION TYPE**: SCHEDULE 13D/A

**PUBLIC DOCUMENT COUNT**: 1

**FILED AS OF DATE**: 20260602

**DATE AS OF CHANGE**: 20260602

**SUBJECT COMPANY**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** PACIFIC HEALTH CARE ORGANIZATION INC
- **CENTRAL INDEX KEY:** 0001138476
- **STANDARD INDUSTRIAL CLASSIFICATION:** SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090]
- **ORGANIZATION NAME:** 08 Industrial Applications and Services
- **EIN:** 870285238
- **STATE OF INCORPORATION:** UT
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** SCHEDULE 13D/A
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 005-78744
- **FILM NUMBER:** 261056298

**BUSINESS ADDRESS:**
- **STREET 1:** 19800 MACARTHUR BOULEVARD
- **STREET 2:** SUITES 306 & 307
- **CITY:** IRVINE
- **STATE:** CA
- **ZIP:** 92612
- **BUSINESS PHONE:** (949) 721-8272

**MAIL ADDRESS:**
- **STREET 1:** 19800 MACARTHUR BOULEVARD
- **STREET 2:** SUITES 306 & 307
- **CITY:** IRVINE
- **STATE:** CA
- **ZIP:** 92612
**FILED BY**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** KUBOTA TOM
- **CENTRAL INDEX KEY:** 0001271519

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** SCHEDULE 13D/A

**MAIL ADDRESS:**
- **STREET 1:** 615 BAY HILL DR
- **CITY:** NEWPROT BEACH
- **STATE:** CA
- **ZIP:** 92660

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## SCHEDULE 13D

### Under the Securities Exchange Act of 1934

**(Amendment No. 22)**

**PACIFIC HEALTH CARE ORGANIZATION INC**

*(Name of Issuer)*

**Common Stock, $.001 par value per share**

*(Title of Class of Securities)*

**—**

*(CUSIP Number)*

**Tom Kubota**<br>2618 San Miguel Drive, #477<br>Newport Beach CA 92660<br>(949) 721-8272

*(Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications)*

**05/27/2026**

*(Date of Event Which Requires Filing of this Statement)*

| **CUSIP No.** | **—** |

---

| | | | |
|:--|:--|:--|:--|
| 1 | Name of reporting person<br>**Tom Kubota** | Name of reporting person<br>**Tom Kubota** | |
| 2 | Check the appropriate box if a member of a Group (See Instructions)<br>[x] (a)<br>[ ] (b) | Check the appropriate box if a member of a Group (See Instructions)<br>[x] (a)<br>[ ] (b) | |
| 3 | SEC use only | SEC use only | |
| 4 | Source of funds (See Instructions)<br>**PF** | Source of funds (See Instructions)<br>**PF** | |
| 5 | Check if disclosure of legal proceedings is required pursuant to Items 2(d) or 2(e)<br>[ ] | Check if disclosure of legal proceedings is required pursuant to Items 2(d) or 2(e)<br>[ ] | |
| 6 | Citizenship or place of organization<br>**X1** | Citizenship or place of organization<br>**X1** | |
| Number of Shares<br>Beneficially Owned by<br>Each Reporting Person With: | 7 | Sole Voting Power<br>**8491258.00** |
| Number of Shares<br>Beneficially Owned by<br>Each Reporting Person With: | 8 | Shared Voting Power<br>**0.00** |
| Number of Shares<br>Beneficially Owned by<br>Each Reporting Person With: | 9 | Sole Dispositive Power<br>**8491258.00** |
| Number of Shares<br>Beneficially Owned by<br>Each Reporting Person With: | 10 | Shared Dispositive Power<br>**0.00** |
| 11 | Aggregate amount beneficially owned by each reporting person<br>**8491258.00** | Aggregate amount beneficially owned by each reporting person<br>**8491258.00** | |
| 12 | Check if the aggregate amount in Row (11) excludes certain shares (See Instructions)<br>[ ] | Check if the aggregate amount in Row (11) excludes certain shares (See Instructions)<br>[ ] | |
| 13 | Percent of class represented by amount in Row (11)<br>**66.3%** | Percent of class represented by amount in Row (11)<br>**66.3%** | |
| 14 | Type of Reporting Person (See Instructions)<br>**IN** | Type of Reporting Person (See Instructions)<br>**IN** | |

---

**Comment for Reporting Person:** (1) With respect to the share numbers set forth in rows 7, 9 and 11 in the table above, these consist of 8,475,258 shares of the Issuer's Common Stock and 16,000 shares of the Issuer's Series A Preferred Stock owned by the Reporting Person. The Series A Preferred Stock is convertible to Common Stock of the Issuer on a one-share-for-one-share basis, based on the number of shares of Series A Preferred Stock converted and not the number of votes represented by such converted shares of Series A Preferred Stock. The Series A Preferred Stock is convertible only by the holder thereof and is convertible at any time. Each outstanding share of Series A Preferred Stock is entitled to vote as 20,000 shares of Common Stock.

(2) With respect to the shares referenced in rows 7, 9 and 11 in the table above, they are held through the Tom Kubota Revocable Trust of 2013 (the "Trust"). The Reporting Person is the sole Trustee of the Trust and may be deemed to have voting and dispositive power over the shares held by the Trust.

(3) With respect to the percentage set forth in row 13 in the table above, it is calculated based on 12,816,000 shares of Common Stock of the Issuer, including 12,800,000 shares of Common Stock outstanding as of March 31, 2026, as reported in the Issuer's Quarterly Report on Form 10-Q filed with the SEC on April 30, 2026, and assuming the issuance of 16,000 shares of Common Stock as if the Reporting Person had converted the 16,000 shares of the Issuer's Series A Preferred Stock held by him to 16,000 shares of Common Stock of the Issuer.

EXPLANATORY NOTE

This Amendment No. 22 ("Amendment No. 22"), dated June 2, 2026, amends and supplements the original Schedule 13D filed by the Reporting Person with the Securities and Exchange Commission (the "Commission") on June 27, 2008, relating to shares of Common Stock, $0.001 par value per share ("Common Stock") of Pacific Health Care Organization, Inc. (the "Issuer"), as amended and supplemented by Schedule 13D/A-1 filed on August 28, 2008, Schedule 13D/A-2 filed on May 14, 2010, Schedule 13D/A-3 filed on May 14, 2010, Schedule 13D/A-4 filed on April 20, 2012, Schedule 13D/A-5 filed on May 21, 2013, Schedule 13D/A-6 filed March 12, 2014, Schedule 13D/A-7 filed April 30, 2014, Schedule 13D/A-8 filed on June 10, 2014, Schedule 13D/A-9 filed on June 17, 2014, Schedule 13D/A-10 filed on March 31, 2015, Schedule 13D/A-11 filed on November 16, 2015, Schedule 13D/A-12 filed on November 18, 2015, and Schedule 13D/A-13 filed on December 1, 2016, Schedule 13D/A-14 filed on January 10, 2018, Schedule 13D/A-15 filed on May 1, 2018, Schedule 13D/A-16 filed on May 16, 2018, Schedule 13D/A-17 filed on January 31, 2020, Schedule 13D/A-18 filed on March 30, 2020, Schedule 13D/A-19 filed on December 29, 2021, Schedule 13D/A-20 filed on August 31, 2023, and Schedule 13D/A-21 filed on September 28, 2023 (collectively referred to herein as the "Schedule 13D").  Only those items hereby reported in this Amendment No. 22 are amended and all other items remain unchanged. Terms used herein but not otherwise defined shall have the meanings set forth in the Schedule 13D.

**Item 1. Security and Issuer**

**(a) Title of Class of Securities:**
Common Stock, $.001 par value per share

**(b) Name of Issuer:**
PACIFIC HEALTH CARE ORGANIZATION INC

**(c) Address of Issuer's Principal Executive Offices:**
19800 MacArthur Boulevard, Suites 306 & 307, Irvine, CA, 92612

**Item 4. Purpose of Transaction**

Item 4 of the Schedule 13D is hereby amended and restated as follows:

The acquisitions were not for the purpose of changing control of the Issuer.  Prior to and following the acquisitions, the Reporting Person was and continues to be the Chief Executive Officer, President and Chairman of the board of directors (the "Board") of the Issuer.  Prior to the acquisitions, the Reporting Person was the single largest holder of Common Stock of the Issuer, owning approximately 65.7% of the outstanding Common Stock of the Issuer. The Reporting Person made the acquisitions because the shares were available for sell and he chose to acquire them. The Reporting Person anticipates he will make additional acquisitions from time-to-time. The Reporting Person did not make the acquisitions with intent to or for the purpose of effecting any of the transactions described in subparagraphs (b) through (j) of Item 4 of Schedule 13D.  It is anticipated that future acquisitions by the Reporting Person would also not be for the purpose of effecting any of the transactions described in (b) through (j) of Item 4 of Schedule 13D.  The Reporting Person may, at any time, review or reconsider his position with respect to the Issuer and formulate plans or proposals with respect to any of the matters described in subparagraphs (a) through (j) of Item 4 of Schedule 13D.

**Item 5. Interest in Securities of the Issuer**

**(a)**
Item 5(a) of the Schedule 13D is hereby amended and restated as follows:

Through the Trust the Reporting Person beneficially owns 8,475,258 shares of Common Stock and 16,000 shares of Series A Preferred Stock of the Issuer. The Reporting Person's beneficial ownership of Common Stock represents approximately 66.3% of the Issuer's Common Stock, based on the number of Common Stock outstanding as disclosed in the Issuer's Quarterly Report on Form 10-Q filed with the SEC on April 30, 2026. The Series A Preferred Stock converts into Common Stock of the Issuer on a one-share-for-one-share basis, based on the number of shares of Series A Preferred Stock converted, at the election of the Reporting Person and has no expiration date; however, as of the date hereof, the Reporting Person has not converted any shares of the Series A Preferred Stock.

**(b)**
Item 5(b) of the Schedule 13D is hereby amended and restated as follows:

As sole Trustee of the Trust, the Reporting Person may be deemed to have the sole power to vote or direct the vote, and sole power to dispose or direct the disposition, of all shares held by the Trust.

**(c)**
Item 5(c) of the Schedule 13D is hereby amended and restated as follows:

On May 27, 2026, the Reporting Person acquired 65,258 shares of Common Stock of the Issuer on the open market for $1.00 per share. Other than the foregoing, the Reporting Person has not engaged in any transactions in the Common Stock of the Issuer during the past sixty days.

**Item 6. Contracts, Arrangements, Understandings or Relationships With Respect to Securities of the Issuer.**

None.

### SIGNATURE

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

**Reporting Person:** Tom Kubota

**Signature:** /s/ Tom Kubota

**Name/Title:** Tom Kubota

**Date:** 06/02/2026