-----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, P9f2XJZx8tNOLMRmxjxF6S/UNkyraTrspwtmd/rsRx95L3NR6bysqEgvoQMDYLb3 HArTu+za1QkOqg04EoEbEw== 0000950144-01-002715.txt : 20010223 0000950144-01-002715.hdr.sgml : 20010223 ACCESSION NUMBER: 0000950144-01-002715 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001231 FILED AS OF DATE: 20010214 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: 1544842 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: RASH MARTIN S CENTRAL INDEX KEY: 0001057322 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR 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 g66893je5.txt PROVINCE HEALTHCARE COMPANY 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(1) | 2. Issuer Name and Ticker or Trading Symbol |6. Relationship of Reporting Person to | | RASH MARTIN S. | PROVINCE HEALTHCARE COMPANY (PRHC) | Issuer (Check all applicable) | |--------------------------------------------|---------------------------------------------| | | (Last) (First) (Middle) | 3. IRS Identification |4. Statement For | [X] Director [ ] 10% Owner | | | Number of Reporting | Month/Year | | | 105 WESTWOOD PLACE, SUITE 400 | Person, if an entity | 12/2000 | [X] Officer (give [ ] Other (specify| |--------------------------------------------| (Voluntary) |-------------------| title below) | | (Street) | |5. If Amendment, | below) | | | | Date of Original| Chairman of the Board, President & CEO| | | | (Month/Year) |---------------------------------------| | BRENTWOOD, TN 37027 | | |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 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) | | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | 542,544 | | | | Common Stock | 12/20/00 | G | 54,079 | D | | (See Note 1) | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | |--------------------------|-----------------|-------------|--------|--------|--------|-------------------|-------------|----------| | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ * 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 | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | See | |Common| | | | Stock Options | $17.25 | 5/3/00 | A | 53,124| | Note 2 | 5/3/10 |Stock | 53,124 | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | |-----------------------|------------|-----------|-----------|-------|--------|--------|--------|------|------------|--------------| | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------ | 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) | | | | | | | |--------------------|--------------------------|----------------------| | 53,124 | D | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | |--------------------|--------------------------|----------------------| | | | | - ------------------------------------------------------------------------ Explanation of Responses: Note 1: The number of securities beneficially owned at the end of the year has been adjusted to reflect the gifts being reported in Table 1 and to correct the amount reported on the Reporting Person's Form 4 filed on October 10, 2000, which did not properly reflect the adjustment for the Company's 3-for-2 stock split that became effective September 28, 2000. 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. /s/ Martin S. Rush 2/13/01 ** Intentional misstatements or omissions of facts constitute -------------------------------- ------------------ Federal Criminal Violations. **Signature of Reporting Person Date 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 (7-97)
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