4 1 l98889ae4.htm ANTHONY & SYLVAN/JORGENSON FORM 4 Anthony & Sylvan/Jorgenson Form 4
 

OMB APPROVAL
OMB Number: 3235-0287
Expires: January 31, 2005
Estimated average burden
hours per response...0.5


UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

FORM 4

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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(h) of the Investment Company Act of 1940

o Check this box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b)

1. Name and Address of Reporting
Person*
(Last, First, Middle)
2. Issuer Name and Ticker or
Trading Symbol
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Jorgenson, Mary Ann
  Anthony & Sylvan Pools Corporation - (SWIM)
 
  Squire, Sanders & Dempsey L.L.P.
4900 Key Tower 127 Public Square

4. Statement for (Month/Day/Year) 5. If Amendment, Date of Original (Month/Day/Year)
    12/01/02
 
  (Street) 6. Relationship of Reporting Person(s) to Issuer (Check All Applicable) 7. Individual or Joint/Group Filing
(Check Applicable Line)
  Cleveland, OH 44114
(City)                (State)           (Zip)
  x  Director o  10% Owner   x Form filed by One Reporting Person
    o  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)  
       
     

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 4(b)(v).
 

 


 


Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security
(Instr. 3)
2. Transaction Date
(Month/Day/Year)
2a. Deemed Execution
Date, if any.

(Month/Day/Year)
3. Transaction Code
(Instr. 8)
4. Securities Acquired (A)
or Disposed of (D)

(Instr. 3, 4 and 5)
5. Amount of Securities
Beneficially Owned
Following Reported
Transactions(s)

(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)

(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

              Code V   Amount (A)
or
(D)
Price            

  Common Shares   12/01/2002   A   5,011   A $4.99 (1)     16,999 (2) (4)     I   by trustee bank

                42,885 (4)     D  

                     

                     

                     

                     

                     

                   

                   

                   

Page 2


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative
Security

(Instr. 3)
2. Conversion or Exercise
Price of Derivative
Security
3. Transaction
Date

(Month/Day/Year)
3a. Deemed Execution
Date, if any

(Month/Day/Year)
4. Transaction
Code

(Instr. 8)
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)

(Instr. 3, 4 and 5)

                      Code V   (A) (D)

  Stock option (4)   $5.66     02/21/2002     A V   10,769

  Stock option (4)   $5.84     05/01/2002     A V   1,210

             

             

             

             

             

             

             

             

Page 3


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date

(Month/Day/Year)
7. Title and Amount
of Underlying Securities

(Instr. 3 and 4)
8. Price of Derivative
Security

(Instr. 5)
9. Number of Derivative
Securities Beneficially Owned
Following Reported Transaction(s)

(Instr. 4)
10. Ownership Form of
Derivative Security:
Direct (D) or Indirect (I)

(Instr. 4)
11. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

  Date
Exercisable
Expiration
Date
  Title Amount or
Number of
Shares
                       

  (3) 02/20/2012   Common Shares 10,769         10,769     D  

  05/01/2002 04/30/2012   Common Shares 1,210         1,210     D  

                 

                 

                 

                 

                 

                 

                 

                 

Explanation of Responses:

1. Represents an average price for shares acquired as annual compensation for services as a director.

2. Represents common shares held indirectly under the Deferred Compensation Plan for Employees and Directors, some of which were previously reported as phantom shares held directly under that Plan.

3, This option vests on February 21, 2007 or, if earlier, at such time as a specified average trading price is achieved for the shares.

4. Amount of common shares beneficially owned includes shares issued pursuant to 10% stock dividends issued to shareholders of record on May 16, 2002 and November 15, 2002. Under the terms of the Long-Term Incentive Plan, the number of shares covered by outstanding options and the related option exercise prices have been proportionately adjusted to reflect those stock dividends.

/s/ Mary Ann Jorgenson   2/12/2003

**Signature of Reporting Person
 
Date


**   Intentional misstatements or omissions of facts constitute Federal 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 is insufficient, see Instruction 6 for procedure.
 

Page 4