3 1 g73589e3.txt PROVINCE HEALTHCARE COMPANY/STEPHEN M. RAY -------- FORM 3 -------- U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 (Print or Type Responses) ------------------------------------------------------------------------------------------------------------------------------------ |1. Name and Address of Reporting Person* |2. Date of Event Requiring |4. Issuer Name and Ticker or Trading Symbol | | | Statement | | | Ray Stephen M. | (Month/Day/Year) | | |------------------------------------------| | Province Healthcare Company ("PRHC") | | (Last) (First) (Middle) | |-----------------------------------------------------------| | | 01/02/2002 |5. Relationship of Reporting | 6. If Amendment, Date | | 105 Westwood Place, Suite 400 |---------------------------| Person(s) to Issuer | of Original | |------------------------------------------|3. IRS or Social Security | (Check all applicable) | (Month/Day/Year) | | (Street) | Number of Reporting | | | | | Person |[ ] Director [ ] 10% Owner | | | | (Voluntary) | | | | | |[X] Officer [ ] Other (specify| | | | | (give below) |-------------------------| | | | title below) | 7. Individual or Joint/ | | | | Senior Executive Vice | Group Filing (Check | | | | President, Finance and Chief | applicable line) | | Brentwood TN 37027 | | Financial Officer | | |--------------------------------------------------------------------------------------------------------| | | (City) (State) (Zip) | [X] Form Filed by | | | One Reporting | | | Person | | | [ ] Form Filed by | | | More Than One | | | Reporting Person | |----------------------------------------------------------------------------------------------------------------------------------| | TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED | |----------------------------------------------------------------------------------------------------------------------------------| |1. Title of Security | 2. Amount of Securities | 3. Ownership Form: | 4. Nature of Indirect | | (Instr. 4) | Beneficially Owned | Direct (D) or | Beneficial | | | (Instr. 4) | Indirect (I) | Ownership (Instr. 5) | | | | (Instr. 5) | | |----------------------------------------|------------------------------|---------------------------|------------------------------| | | | | | |----------------------------------------|------------------------------|---------------------------|------------------------------| | | | | | |----------------------------------------|------------------------------|---------------------------|------------------------------| | | | | | |----------------------------------------|------------------------------|---------------------------|------------------------------| | | | | | |----------------------------------------|------------------------------|---------------------------|------------------------------| | | | | | |----------------------------------------|------------------------------|---------------------------|------------------------------| | | | | | |----------------------------------------|------------------------------|---------------------------|------------------------------| | | | | | |----------------------------------------|------------------------------|---------------------------|------------------------------| | | | | | -----------------------------------------------------------------------------------------------------------------------------------
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 5(b)(v). 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. (Over) SEC 1473 (7-97)
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------------ | 1. Title of Derivative Security |2. Date |3. Title and Amount of |4. Conver- | 5. Owner- |6. Nature of Indirect| | (Instr. 4) | Exercisable and | Securities Underlying | sion or | ship | Beneficial Owner- | | | Expiration Date | Derivative Securities | Exercise | Form of | ship (Instr. 5) | | | (Month/Day/Year) | (Instr. 4) | Price of | Deriva- | | | | | | Deriva- | tive | | | | | | tive | Security:| | | | | | Security | Direct | | | |--------------------|--------------------------| | (D) or | | | | Date | Expira- | | Amount or | | Indirect | | | | Exercis-| tion | Title | Number of | | (I) | | | | able | Date | | Shares | | (Instr. | | | | | | | | | 5) | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | Stock Options |See Note 1| 12/13/11| Common Stock | 172,131 | $27.25 | D | | | | | | | | per | | | | | | | | | share | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | |---------------------------------|----------|---------|--------------|-----------|------------|-------------|---------------------| | | | | | | | | | ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: Note 1: 34,426 options vest on each of December 13, 2002, December 13, 2003, December 13, 2004 and December 13, 2005 and 34,427 options vest on December 13, 2006. /s/ Stephen M. Ray 1/7/02 ** Intentional misstatements or omissions of facts constitute Federal Criminal ------------------------------- ---------- 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 is insufficient, See Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not Page 2 required to respond unless the form displays a currently valid OMB Number. SEC 1473 (7-97)