5 1 g66893ce5.txt PROVINCE HEALTHCARE COMPANY/WINFIELD C. DUNN 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) | | Dunn Winfield C. | Province Healthcare Company (PRHC) | to Issuer (Check all applicable) | |--------------------------------------------|---------------------------------------------| | | (Last) (First) (Middle) | 3. IRS Identification |4. Statement For | [X] Director [ ] 10% Owner | | | Number of Reporting | Month/Year | | | 107 Dunham Springs Lane | Person, if an Entity | 12/2000 | [ ] Officer (give [ ] Other (specify| |--------------------------------------------| (Voluntary) |-------------------| title below) | | (Street) | |5. If Amendment, | below) | | | | Date of Original| | | | | (Month/Year) |---------------------------------------| | Nashville TN 37205 | | |7. Individual or Joint/Group Reporting | |--------------------------------------------|---------------------------------------------| (Check applicable line) | | (City) (State) (Zip) | | [X] 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. | | 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 | | (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 (Over) contained in this form are not required to respond unless the form displays SEC 2270 (7-97) 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 | $14.25 | 3/14/00 | A | 22,500| |See Note| 3/14/10|Common| 22,500 | | | | | | | | | 1 | |Stock | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | Stock Options | $17.25 | 5/3/00 | A | 45,000| |See Note| 5/3/10 |Common| 45,000 | | | | | | | | | 2 | |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) | | | | | | | |--------------------|--------------------------|----------------------| | 22,500 | D | | | | | | |--------------------|--------------------------|----------------------| | 45,000 | D | | | | | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | ------------------------------------------------------------------------ Explanation of Responses: Note 1: The options were granted under the 1997 Long Term Equity Incentive Plan and vest in five equal annual installments beginning on March 14, 2001. Note 2: The options were granted under the 1997 Long Term Equity Incentive Plan and vest in five equal annual installments beginning on May 3, 2001. ** Intentional misstatements or omissions of facts constitute Federal Criminal /s/ Winfield C. Dunn 1/19/01 Violations. 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 number. Page 2 SEC 2270 (7-97)