-----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, UG5gqIUKDWkJnuNzH2I2pTnV04Hg4ocJGPPLu+YiRodzYD55A7EwzJnR9PCOXV0c J6PVo68cNO2gxTkO13WhUw== 0000950144-00-001639.txt : 20000210 0000950144-00-001639.hdr.sgml : 20000210 ACCESSION NUMBER: 0000950144-00-001639 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991231 FILED AS OF DATE: 20000209 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PROVINCE HEALTHCARE CO CENTRAL INDEX KEY: 0001044942 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-GENERAL MEDICAL & SURGICAL HOSPITALS, NEC [8062] IRS NUMBER: 621710772 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-23639 FILM NUMBER: 528897 BUSINESS ADDRESS: STREET 1: 105 WESTPARK DR STREET 2: STE 400 CITY: BRENTWOOD STATE: TN ZIP: 37027 BUSINESS PHONE: 6153701377 MAIL ADDRESS: STREET 1: 105 WESTPARK DR SUITE 180 STREET 2: 105 WESTPARK DR SUITE 180 CITY: BRENTWOOD STATE: TN ZIP: 37207 COMPANY DATA: COMPANY CONFORMED NAME: WALL HOWARD T III CENTRAL INDEX KEY: 0001057317 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 109 WESTPARK DR STREET 2: STE 180 CITY: BRENTWOOD STATE: TN ZIP: 37027 MAIL ADDRESS: STREET 1: 109 WESTPARK DR STREET 2: STE 180 CITY: BRENTWOOD STATE: TN ZIP: 37027 FORMER COMPANY: FORMER CONFORMED NAME: WALL HOWARD I III DATE OF NAME CHANGE: 19980309 5 1 PROVINCE HEALTHCARE COMPANY/HOWARD WALL,III 1 - ------ FORM 5 - ------ / / Check box if no U.S. SECURITIES AND EXCHANGE COMMISSION longer subject to WASHINGTON, DC 20549 Section 16. Form 4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP obligations may continue. See Filed pursuant to Section 16(a) of the Securities Instruction 1(b) Exchange Act of 1934, / / Form 3 Holdings Section 17(a) of the Public Utility Reported Holding Company Act of 1935 or Section 30(f) of / / Form 4 the Investment Company Act Transactions of 1940 Reported - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Wall, III Howard T. Province Healthcare Company (PRHC) Issuer (Check all applicable) - ------------------------------------------- ---------------------------------------------- Director 10% Owner (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- --- 105 Westwood Place, Suite 400 Number of Reporting Month/Year X Officer (give Other (specify - ------------------------------------------- Person (Voluntary) 12/99 ---- title --- below) (Street) ------------------- below) Brentwood Tennessee 37027 5. If Amendment, Senior Vice President/Secretary - ------------------------------------------- Date of Original ------------------------------- (City) (State) (Zip) (Month/Year) 7. Individual or Joint/Group Filing ------------------ (Check applicable line) Form Filed by one ---- Reporting Person Form Filed by more than ---- one Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature (Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In- Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct (Instr. 8) End of Issuer's Direct Benefi- (Month/ Fiscal Year (D) or cial Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner- Year) Amount (A) or Price (I) ship (D) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ *If the form is filed by more than one reporting person, see instruction 4(b)(v). Potential persons who are not to respond to the collection of information contained in this form are (Over) not required to respond unless the form displays a currently valid OMB control number. SEC 2270 (3-99)
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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 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price Security sion or action action Derivative cisable and of Underlying of (Instr. 3) Exercise Date Code Securities Expiration Securities Deriv- Price of (Month/ (Instr. Acquired (A) Date (Instr. 3 and 4) ative Deriv- Day/ 8) or Disposed (Month/Day/ Secur- ative Year) of (D) Year) ity Security (Instr. 3, (Instr. 5) 4, and 5) ----------------------------------- Date Expira- Amount or --------------- Exer- tion Title Number of (A) (D) cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ Stock Options $15.125 2/25/99 A 15,900 (1) 2/24/04 Common 15,900 (right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Stock Options $14.25 7/14/99 A 8,584 (2) 7/13/04 Common 8,584 (right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------- 1. Title of Derivative 9. Number of 10. Ownership 11. Nature of Security Derivative of Derivative Indirect (Instr. 3) Securities Security: Beneficial Beneficially Direct (D) Ownership Owned at End or Indirect (I) (Instr. 4) of Year (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------- Stock Options 15,900 D (right to buy) - ------------------------------------------------------------------------------------------------------- Stock Options 8,584 D (right to buy) - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) The options were granted under the 1997 Long Term Equity Incentive Plan and vest in five equal annual installments beginning on February 25, 2000. (2) The options were granted under the 1997 Long Term Equity Incentive Plan and were fully vested on the transaction date. **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Howard T. Wall, III 1/21/00 See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- ------- **Signature of Reporting Person Date 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 control number. Page 2 SEC 2270 (3-99)
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