-----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, VGnEfL2MFbpYnCslPO87+eKluaXPWWpSxNWQeEsK814XeALZ155B5lHeR+Q+iHfm PTTnZzIt6MUErt3gn9P5Cg== 0001014739-03-000003.txt : 20030122 0001014739-03-000003.hdr.sgml : 20030122 20030122104110 ACCESSION NUMBER: 0001014739-03-000003 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030122 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: BOMAR RECIE CENTRAL INDEX KEY: 0001215066 RELATIONSHIP: OTHER FILING VALUES: FORM TYPE: 5 MAIL ADDRESS: STREET 1: C/O MIM CORPORATION STREET 2: 100 CLEARBROOK ROAD CITY: ELMSFORD STATE: NY ZIP: 10523 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MIM CORP CENTRAL INDEX KEY: 0001014739 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 050489664 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-28740 FILM NUMBER: 03520353 BUSINESS ADDRESS: STREET 1: 100 CLEARBROOK RD CITY: ELMSFORD STATE: NY ZIP: 10523 BUSINESS PHONE: 9147353555 MAIL ADDRESS: STREET 1: 25 NORTH ROAD CITY: PEACE DALE STATE: RI ZIP: 02883 5 1 bom6.htm FORM 5 SEC Form 5
FORM 5

[X] Check this box if no longer
subject to Section 16. Form 4 or Form
5 obligations may continue.
See Instruction 1(b).

[ ]Form 3 Holdings Reported
[X]Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C.  20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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(h) of the Investment Company Act of 1940
OMB APPROVAL



OMB Number: 3235-0362
Expires: January 31, 2005
Estimated average burden
hours per response. . . . . 0.5
1. Name and Address of Reporting Person*
Bomar, Recie     B.

(Last)                      (First)                      (Middle)
100 Clearbrook Road


(Street)
Elmsford, NY     10523

(City)                      (State)                      (Zip)

2. Issuer Name and Ticker or Trading Symbol

MIM Corporation   MIMS
6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

                        Director                           10% Owner
                        Officer                             Other

Officer/Other
Description                              

7. Individual or Joint/Group
    Filing (Check Applicable Line)

X   Individual Filing
      Joint/Group Filing
3. I.R.S. Identification
    Number of Reporting
    Person, if an entity
    (voluntary)
4. Statement for
    Month/Day/Year

    December 31, 2002


5. If Amendment,
    Date of Original
    (Month/Day/Year)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security
    (Instr. 3)

2. Transaction Date
    (Month/Day/Year)
2A. Deemed
      Execution
      Date, if any

      (Month/Day/Year)
3. Transaction
    Code
    (Instr. 8)
4. Securities Acquired (A) or Disposed (D) Of
    (Instr. 3, 4, and 5)





        Amount      |         A/D         |         Price          
5. Amount of
    Securities
    Beneficially
    Owned at
    End of
    Issuer's Fiscal
    Year

    (Instr. 3 and 4)
6. Owner-
    ship
    Form:
    Direct(D)
    or
    Indirect (I)

    (Instr. 4)
7. Nature of
     Indirect
     Beneficial
     Ownership

    (Instr. 4)
Common Stock, $.0001 par value




25000 (1)
D









If the form is filed by more than one reporting person, see instruction 4(b)(v).
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.
(over)
SEC 2270 (7-02)

Bomar, Recie B. - December 31, 2002
Form 5 (continued)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
    (Instr. 3)
2. Conver-
    sion or
    Exercise
    Price of
    Deri-
    vative
    Security
3. Transaction
    Date

    (Month/
    Day/
    Year)
3A. Deemed
      Execution
      Date, if
      any

      (Month/
      Day/
      Year)
4. Transaction
    Code
5. Number of Derivative
    Securities Acquired (A)
    or Disposed (D) Of

    (Instr. 3,4 and 5)
6. Date Exercisable(DE) and
    Expiration Date(ED)
    (Month/Day/Year)






  (DE)     |     (ED)  
7. Title and Amount of
    Underlying Securities
    (Instr. 3 and 4)
8. Price
    of
    Derivative
    Security
    (Instr.5)
9. Number of
    Derivative
    Securities
    Beneficially
    Owned
    at End of
    Year
    (Instr.4)
10.
Owner-
ship
Form of
Deriv-
ative
Security:
Direct
(D)
or
Indirect
(I)
(Instr.4)
11. Nature of
      Indirect
      Beneficial
      Ownership
      (Instr.4)
Employee Stock Option (Right to Buy Common Stock)
$11.0500 09/16/2002

A
    (A) 10000
09/16/2003 (2) | 09/16/2012
Common Stock, $.0001 par value - 10000
10000
D

Employee Stock Option (Right to Buy Common Stock)
$12.2000



11/28/2002 (2) | 11/28/2011
Common Stock, $.0001 par value - 50000
50000
D













Explanation of Responses :


** 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 is insufficient,
            see Instruction 6 for procedure.

Potential persons who are to respond to the collection of information contained in this form are not
required to respond unless the form displays a currently valid OMB number.
/s/ Recie B. Bomar                   01-22-2003    
** Signature of Reporting Person                         Date




Page 2

Bomar, Recie B. - December 31, 2002
Form 5 (continued)
FOOTNOTE Descriptions for MIM Corporation MIMS

Form 5 - December 2002

Recie B. Bomar
100 Clearbrook Road

Elmsford, NY 10523

Explanation of responses:

(1)   On June 1, 1999, the Company issued to Mr. Bomar 25,000 restricted shares of Common Stock. Such shares are subject to restrictions on transfer and encumbrance through December 31, 2006 and are automatically forfeited to the Company upon the termination of Mr. Bomar's employment with the Company prior to December 31, 2006. The restrictions to which the restricted shares are subject may lapse prior to December 31, 2006 upon the achievement by the Company of certain specified levels of earnings per share in fiscal 2002.
(2)   Vests and becomes exercisable in three equal annual installments commencing on the first anniversary of the date of grant.
Page 3
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