-----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, NO/r29Zn6YlZuPTUM5UaJkPZsTXKVlVf0RZIZrQRDWPGpeKle+uImS/ZRvp/KLSf wf1VJ1/NORJCe4JVP7GFWQ== 0000950144-00-005855.txt : 20000504 0000950144-00-005855.hdr.sgml : 20000504 ACCESSION NUMBER: 0000950144-00-005855 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991231 FILED AS OF DATE: 20000503 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: 618496 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: ANDERSON JAMES THOMAS CENTRAL INDEX KEY: 0001057319 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 5 1 PROVINCE HEALTHCARE COMPANY/JAMES T. ANSERSON 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(s) | | Anderson James Thomas | Province Healthcare Company (PRHC) | to Issuer (Check all applicable) | |--------------------------------------------|---------------------------------------------| | | (Last) (First) (Middle) | 3. IRS Identification |4. Statement For | [ ] Director [ ] 10% Owner | | | Number of Reporting | Month/Year | | | 105 Westwood Place, Suite 400 | Person, if an Entity | 12/99 | [X] Officer (give [ ] Other (specify| |--------------------------------------------| (Voluntary) |-------------------| title below) | | (Street) | |5. If Amendment, | below) | | | | Date of Original| Senior Vice President of Acquisitions | | | | (Month/Year) | and Development | | | | |---------------------------------------| | Brentwood, Tennessee 37027 | | 2/00 |7. Individual or Joint/Group Filing | |--------------------------------------------|---------------------------------------------| (Check applicable line) | | (City) (State) (Zip) | | [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 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. | | End of Issuer's | Direct | Benefi-| | | (Month/ | 8) | | Fiscal Year | (D) or | cial | | | Day/ | |--------------------------| (Instr. 3 and 4)| Indirect | Owner- | | | Year) | | Amount | (A) or | Price | | (1) | ship | | | | | | (D) | | | (Instr. 4)| (Instr.| | | | | | | | | | 4) | | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | Common Stock | | | | | | 28,249 shares(1) | D | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ (1) End of period holdings have been updated to include 249 shares of Common Stock acquired under the 1998 Employee Stock Purchase Plan. * If the form is filed by more than one reporting person, POTENTIAL PERSONS WHO ARE NOT TO RESPOND TO THE (Over) see instruction 4(b)(v). COLLECTION OF INFORMATION CONTAINED IN THIS FORM SEC 2270 (3-99) ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER.
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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 | 6,169 | | (2) |7/13/04 |Common| 6,169 | | | (right to buy) | | | | | | | |Stock | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------ | 9. Number of | 10. Ownership | 11. Nature of | | Derivative | of Derivative | Indirect | | Securities | Security: | Beneficial | | Beneficially | Direct (D) | Ownership | | Owned at End | or Indirect (I) | (Instr. 4) | | of Year | (Instr. 4) | | | (Instr. 4) | | | | | | | |--------------------|--------------------------|----------------------| | 15,900 | D | | |--------------------|--------------------------|----------------------| | 6,169 | D | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | - ------------------------------------------------------------------------ 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. /s/ James T. Anderson 4/27/00 ------------------------------------- ---------- ** Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person Date 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 2270 (3-99)
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