5 1 johnson01503.txt FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 5 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 this box if no longer OMB APPROVAL subject to Section 16. Form 4 or OMB Number: 3235-0362 Form 5 obligations may continue. Expires: Pending See Instruction 1(b). Extimated average burden hours per response.....0.5 ------------------------------------------------------------------------------- 1. NAME AND ADDRESS OF REPORTING PERSON* LAST FIRST MIDDLE STREET CITY STATE ZIP Johnson, Stuart B. 3112 Pinehurst Plano TX 75075 ------------------------------------------------------------------------------- 2. ISSUER NAME AND TICKER OR TRADING SYMBOL Advanced Neuromodulation Systems, Inc., OTC - ANSI ------------------------------------------------------------------------------- 3. IRS OR SOCIAL SECURITY NUMBER OF REPORTING PERSON (VOLUNTARY) ###-##-#### ------------------------------------------------------------------------------- 4. STATEMENT FOR MONTH/YEAR 5. IF AMENDMENT, DATE OF ORIGINAL (MONTH/YEAR) December 2002 ------------------------------------------------------------------------------- 6. RELATIONSHIP OF REPORTING PERSON(S) TO ISSUER (Check all applicable) ____ Director _____ 10% Owner _X__ Officer (give _____ Other (specify title below) below) Vice President-Operations ------------------------------------------------------------------------------- 7. INVIDIVUAL OR JOINT/GROUP FILING (Check applicable line) _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 (Instr. 3) | 2. Transaction | 3. Transaction | | | Date | Code | | | (Month/Day/ | (Instr. 8) | | | Year) | | |-------------------------------------|-----------------|----------------------| |Common Stock, $0.05 Par Value | | | |-------------------------------------|-----------------|----------------------| | | | | |-------------------------------------|-----------------|----------------------|
------------------------------------------------------------------------------- |4. Securities Acquired | 5. Amount of | 6. Ownership | 7. Nature of | | (A) or Disposed of | Securities | Form: | Indirect | | (D) (Instr. 3, 4, | Beneficially| Direct (D) | Beneficial | | and 5) | Owned at End| or Indirect| Ownership | | | Issuer's | (I) | (Instr. 4) | | | Fiscal Year | (Instr. 4) | | | | (Instr. 3 | | | -----------------------------| and 4) | | | | | (A) | | | | | | | or | | | | | | Amount | (D) | Price | | | | |-----------|-----|----------|----------------|---------------|----------------| | | | | 41,600 | D | | |-----------|-----|----------|----------------|---------------|----------------| | | | | | | | |-----------|-----|----------|----------------|---------------|----------------|
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) |------------------------------------------------------------------------------| |1. |2. |3. |4. |5. |6. | |Title of |Conver- |Transaction |Trans- |Number of |Date | |Derivative |sion |Date |action |Derivative |Exerciseable | |Security |or |(Month/Day/ |Code |Securities |and | |(Instr. 3) |Exercise |Year) |(Instr. |Acquired (A) or|Expiration | | |Price | |8) |Disposed of (D)|Date | | |of | | |(Instr. 3, 4, |(Month/Day/Year) | | |Deriva- | | |and 5) |-----------------| | |tive | | | |Date |Expira- | | |Security | |--------|-------|-------|Exerc- |tion | | | | | Code | (A) | (D) |isable |Date | |-----------|---------|-------------|--------|-------|-------|--------|--------| |Right to | $5.000 | 11/05/98(1) | A | 17,000| |11/05/98|11/06/08| |Purchase | | | | | | | | |Stock | | | | | | | | |Option | | | | | | | | | | | | | | | | | |Exercise of| | 07/12/02 | D | |17,000 | | | |Option | | | | | | | | |-----------|---------|-------------|--------|-------|-------|--------|--------| |Right to | $5.000 | 11/05/98(2) | A |10,000 | |11/05/98|11/06/08| |Purchase | | | | | | | | |Stock | | | | | | | | |Option | | | | | | | | | | | | | | | | | |Exercise of| | 11/08/02 | D | |10,000 | | | |Option | | | | | | | | |-----------|---------|-------------|--------|-------|-------|--------|--------| |Right to | $6.625 | 03/31/99(1) | A |20,000 | |03/31/00|04/01/09| |Purchase | | | | | | | | |Stock | | | | | | | | |Option | | | | | | | | |-----------|---------|-------------|--------|-------|-------|--------|--------| |Right to | $15.375 | 03/17/00(2) | A | 7,000 | |03/17/01|03/18/10| |Purchase | | | | | | | | |Stock | | | | | | | | |Option | | | | | | | | |-----------|---------|-------------|--------|-------|-------|--------|--------| |Right to | $14.250 | 07/31/00(3) | A |10,000 | |07/31/01|08/01/10| |Purchase | | | | | | | | |Stock | | | | | | | | |Option | | | | | | | | |-----------|---------|-------------|--------|-------|-------|--------|--------| |Right to | $10.625 | 04/03/01(2) | A |10,000 | |04/03/02|04/04/11| |Purchase | | | | | | | | |Stock | | | | | | | | |Option | | | | | | | | |-----------|---------|-------------|--------|-------|-------|--------|--------| |Right to | $28.530 | 02/20/02(2) | A |15,000 | |02/20/03|02/21/12| |Purchase | | | | | | | | |Stock | | | | | | | | |Option | | | | | | | | |-----------|---------|-------------|--------|-------|-------|--------|--------|
|------------------------------------------------------------------------------| |7. |8. |9. |10. |11. | |Title and Amount |Price |Number |Ownership |Nature | |of Underlying |of Derivative|of Derivative|of |of | |Securities |Security |Securities |Derivative |Indirect | |(Inst. 3 and 4) |(Instr. 5) |Beneficially |Security: |Beneficial| |------------------------| |Owned at End |Direct (D) or |Ownership | | |Amount or | |of Year |Indirect (I) |(Instr. 4)| | |Number of | |(Instr. 4) |(Instr. 4) | | | Title |Shares | | | | | |------------|-----------|-------------|-------------|--------------|----------| |Common Stock| 17,000 | | | | | |Common Stock| 17,000 | | | | | |------------|-----------|-------------|-------------|--------------|----------| |Common Stock| 10,000 | | | | | |Common Stock| 10,000 | | | | | |------------|-----------|-------------|-------------|--------------|----------| |Common Stock| 20,000 | | | | | |------------|-----------|-------------|-------------|--------------|----------| |Common Stock| 7,000 | | | | | |------------|-----------|-------------|-------------|--------------|----------| |Common Stock| 10,000 | | | | | |------------|-----------|-------------|-------------|--------------|----------| |Common Stock| 10,000 | | | | | |------------|-----------|-------------|-------------|--------------|----------| |Common Stock| 15,000 | | | | | |------------|-----------|-------------|-------------|--------------|----------| | | | TOTAL | 62,000 | D | | |------------|-----------|-------------|-------------|--------------|----------|
Explanation of Responses: (1) Options granted pursuant to 1995 Stock Option Plan, 25% vesting per year. (2) Options granted pursuant to 1998 Stock Option Plan, 25% vesting per year. (3) Options granted pursuant to 2000 Stock Option Plan, 25% vesting per year. Stuart B. Johnson By:/s/Linda D. Moses, Agent and Attorney-in-Fact for Stuart B. Johnson ----------------------------------------------------- **Signature of Reporting Person Date: February 14, 2003 ----------------------------------------- ** 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 insufficent, 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.