-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, OxxLQ7K4cHNiRlDfDTU1j4cnxZg/WJz3sGwrXW1mPwMzlAonCTpyjgHY84v6tSPW cgi+ZgYuRwKEhN6YSQ2xxg== 0001181431-05-061984.txt : 20051117 0001181431-05-061984.hdr.sgml : 20051117 20051117142802 ACCESSION NUMBER: 0001181431-05-061984 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051115 FILED AS OF DATE: 20051117 DATE AS OF CHANGE: 20051117 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: D ALLAIRD FRANK J CENTRAL INDEX KEY: 0001234984 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23363 FILM NUMBER: 051212254 BUSINESS ADDRESS: STREET 1: 201 EDGEWATER DRIVE CITY: WAKEFIELD STATE: MA ZIP: 01880 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMERICAN DENTAL PARTNERS INC CENTRAL INDEX KEY: 0001028087 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 043297858 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 201 EDGEWATER DRIVE STREET 2: SUITE 285 CITY: WAKEFIELD STATE: MA ZIP: 01880-1249 BUSINESS PHONE: 781-224-0880 MAIL ADDRESS: STREET 1: 201 EDGEWATER DRIVE STREET 2: SUITE 285 CITY: WAKEFIELD STATE: MA ZIP: 01880 4 1 rrd97472.xml X0202 4 2005-11-15 0 0001028087 AMERICAN DENTAL PARTNERS INC ADPI 0001234984 D ALLAIRD FRANK J 201 EDGEWATER DRIVE, SUITE 285 WAKEFIELD MA 01880 0 1 0 0 Senior VP-Regional Operations Common Stock 2005-11-15 4 M 0 3450 5.41 A 2278 D Common Stock 2005-11-15 4 S 0 3450 19.2152 D 2278 D Nonqualified option granted 08/01/2002 (right to buy) 5.41 2005-11-15 4 M 0 3450 0 D 2003-08-01 2012-08-01 Common Stock 3450 7612 D Number of shares reflects the 3-for-2 stock split effected by the issuer in October 2005. Conversion or exercise price reflects the 3-for-2 stock split effected by the issuer in October 2005. Option vests with respect to 25% of shares subject to option on each of the first four anniversaries of the date of grant. Total number of derivative securities beneficially owned (7,612) reflects all options held by reporting person pursuant to employee benefit plans of issuer. Gregory A. Serrao, Attorney-in-Fact and Agent 2005-11-17 -----END PRIVACY-ENHANCED MESSAGE-----