-----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, KpSZrV83zwBMSSfGXSKRiL//J8PSs3NfsGGHsAi8rl2UhzCKZ71WaC4FdrIIR/Qv I5zkUa2Id3WInccjXyPeLQ== /in/edgar/work/20000606/0000930661-00-001482/0000930661-00-001482.txt : 20000919 0000930661-00-001482.hdr.sgml : 20000919 ACCESSION NUMBER: 0000930661-00-001482 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000523 FILED AS OF DATE: 20000606 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: STAFFMARK INC CENTRAL INDEX KEY: 0001017968 STANDARD INDUSTRIAL CLASSIFICATION: [7363 ] IRS NUMBER: 710788538 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-20971 FILM NUMBER: 649497 BUSINESS ADDRESS: STREET 1: 234 EAST MILLSAP CITY: FAYETTEVILLE STATE: AR ZIP: 72703 BUSINESS PHONE: 5019736000 MAIL ADDRESS: STREET 1: 234 EAST MILLSAP CITY: FAYETTEVETTE STATE: AR ZIP: 72703 COMPANY DATA: COMPANY CONFORMED NAME: BELLORA TERRY C CENTRAL INDEX KEY: 0001116106 STANDARD INDUSTRIAL CLASSIFICATION: [ ]OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 234 EAST MILLSAP CITY: FAYETTEVILLE STATE: AR ZIP: 72703 MAIL ADDRESS: STREET 1: 234 EAST MILLSAP CITY: FAYETTEVILLE STATE: AR ZIP: 72703 4 1 0001.txt FORM 4 /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number: 3235-0287 / / Expires: September 30, 1998 / / Estimated average burden / / hours per response...... 0.5 / /------------------------------/ +--------+ | FORM 4 | U.S. SECURITIES AND EXCHANGE COMMISSION +--------+ WASHINGTON, D.C. 20549 [_] Check this box if no longer subject STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP to Section 16. Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities obligations may Exchange Act of 1934, Section 17(a) of the continue. See Public Utility Holding Company Act of 1935 or Instruction 1(b). Section 30(f) of the Investment Company Act of 1940 (Print or Type Responses) - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Bellora, Terry C. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 302 East Millsap Road - -------------------------------------------------------------------------------- (Street) Fayetteville, Arkansas 72703 - -------------------------------------------------------------------------------- (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol Staffmark, Inc. -- STAF ----------------------------------- 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) -------------- 4. Statement for Month/Year May 2000 --------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) --------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) X ___ Director ___ Officer ___ 10% Owner ___ Other (give title below) (specify below) Chief Financial Officer ---------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) X ____ Form filed by One Reporting Person ____ Form filed by More than One Reporting Person Table I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Title 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature of action action or Disposed of (D) Securities ship of In- Security Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Instr. 3) (Month/ (Instr. 8) Owned at Direct Bene- Day/ ----------------------------------------------- End of (D) or ficial Year) Month Indirect Owner- Code V Amount (A) or Price (Instr. 3 and 4) (I) ship (D) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 5/23/00 P V 1,000 A $6.75 1,100 I By Child - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 200 I Trust - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 4(b)(v). (Over) SEC 1474 (7-96) Form 4 (continued) Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
- ----------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- Security (Instr. 3) sion or action tion Code ative Securities Exercise Date (Instr. 8) Acquired (A) or Price of (Month/ Disposed of (D) Deriv- Day/ (Instr. 3, 4, and 5) ative Year) Security --------------------------------------------------- Code V (A) (D) - ----------------------------------------------------------------------------------------------------------------------------- Stock Option $12.00 (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------- Stock Option $12.00 - ----------------------------------------------------------------------------------------------------------------------------- Stock Option $12.875 - ----------------------------------------------------------------------------------------------------------------------------- Stock Option $27.00 - ----------------------------------------------------------------------------------------------------------------------------- Stock Option $24.50 - ----------------------------------------------------------------------------------------------------------------------------- Stock Option $8.625 - ----------------------------------------------------------------------------------------------------------------------------- Stock Option $8.625 - -----------------------------------------------------------------------------------------------------------------------------
Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
- ------------------------------------------------------------------------------------------------------------------------------------ 6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na- cisable and Underlying Securities of of Deriv- ship ture Expiration (Instr. 3 and 4) Deriv- ative Form of In- Date ative Secur- of De- direct (Month/Day/ Secur- ities rivative Bene- Year) ity Bene- Securities ficial (Instr. ficially Bene- Owner- -------------------------------------------- 5) Owned ficially ship Date Expira- Amount or at End Owned at (Instr. Exer- tion Title Number of of End of 4) cisable Date Shares Month Month(1) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ (1) 9/15/06 Common 150,000 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ (2) 10/2/06 Common 10,000 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ (3) 3/3/07 Common 27,500 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ (4) 8/22/07 Common 75,000 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ (4) 1/27/08 Common 14,000 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ (4) 4/19/09 Common 15,000 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ (4) 4/19/09 Common 50,000 341,500 D Stock - ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses:
(1) 25,000 on 10/1/96 (2) 40% on 10/2/98 (3) 40% on 3/3/99 (4) 33-1/3% one year after grant 50,000 on 10/1/97 60% on 10/2/99 60% on 3/3/00 66-2/3% two years after grant 25,000 on each of 10/2/98 80% on 10/2/01 80% on 3/3/01 100% three years after grant 10/1/98, 10/1/99, and 10/1/00 100% on 10/2/01 100% on 3/3/02
/s/ Terry C. Bellora 6/2/2000 ------------------------------- ----------------- **Signature of Reporting Person Date ** 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. 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. Page 2 SEC 1474 (7-96) -----END PRIVACY-ENHANCED MESSAGE-----