-----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, CWbEGON2wAblHY2MM/h2QXfRczegVraqj6HDnnPvKjrD6m4N1Gh6AQT0bCgbQx72 9xyC3vrBt1i6UYV5816p0w== 0001012975-03-000090.txt : 20030415 0001012975-03-000090.hdr.sgml : 20030415 20030415161846 ACCESSION NUMBER: 0001012975-03-000090 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030415 FILED AS OF DATE: 20030415 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: SHAFFER FRANKLIN A CENTRAL INDEX KEY: 0001162519 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 118 PERRY STREET, APT. 539 CITY: NEW YORK STATE: NY ZIP: 10014 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CROSS COUNTRY INC CENTRAL INDEX KEY: 0001141103 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HELP SUPPLY SERVICES [7363] IRS NUMBER: 134066229 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-33169 FILM NUMBER: 03650752 BUSINESS ADDRESS: STREET 1: 6551 PARK OF COMMERCE BLVD STREET 2: SUITE 200 CITY: BOCA RATON STATE: FL ZIP: 33487 BUSINESS PHONE: 8003472264 MAIL ADDRESS: STREET 1: 6551 PARK COMMERCE BLVD STREET 2: SUITE 200 CITY: BOCA RATON STATE: FL ZIP: 33487 4 1 e119931shaffer.txt ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response . . . . 0.5 ------------------------------ U.S. 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(f) of the Investment Company Act of 1940 [_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print or Type Responses) _______________________________________________________________________________ 1. Name and Address of Reporting Person* Shaffer Franklin A. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 118 Perry St. Apt J39 - -------------------------------------------------------------------------------- (Street) New York, NY 10014 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Cross Country, Inc. (CCRN) ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Day/Year 4/11/03 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ ] Director [_] 10% Owner [X] Officer (give title below) [_] Other (specify below) President, Education and Staffing Division ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [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 ================================================================================
5. 6. 4. Amount of Owner- 2A. Securities Acquired (A) or Securities ship Deemed 3. Disposed of (D) Beneficially Form: 7. Execu- Transaction (Instr. 3, 4 and 5) Owned Follwng Direct Nature of 2.Trans- tion Code ------------------------------- Reported (D) or Indirect 1. action Date, (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Date if any ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
(Over) SEC 1474 (9-02) 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). Persons who 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 1 of 2 FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 3A. 4. Securities Date Securities Price Bene- ies: In- cise 3. Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Beneficially direct Price Trans- Execution action or Disposed Expiration Date ---------------- Deriv- Owned Owned Bene- 1. of action Date, Code of(D) (Month/Day/Year) Amount ative Following at ficial Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- Reported end Owner- Derivative ative (Month/ (Month/ 8) 4 and 5) Date Expira- Number ity Transaction(s)of month ship Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Employee $10.38 4/11/03 A 6,000 (1) 4/11/13 Common 6,000 63,723 D Stock Option Stock (Right to Buy) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) The option vests in four equal annual installments beginning on April 11, 2004. Franklin A. Shaffer /s/ Franklin A. Shaffer 4/11/03 - --------------------------------------------- ----------------------- **Signature of Reporting Person Date Name of Reporting Person ** 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 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. 2 of 2 -----END PRIVACY-ENHANCED MESSAGE-----