-----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, G1CwnOqBpdBzDxAA9UXpn90eYcHAlqhbhHoTal48BA4M6LJI0Rpgfo0xxbA0FzHX wZLzrD5+lOhmOZMgHsuGyA== 0000004977-03-000039.txt : 20030211 0000004977-03-000039.hdr.sgml : 20030211 20030211152203 ACCESSION NUMBER: 0000004977-03-000039 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030211 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: SPENCER KATHELEN V CENTRAL INDEX KEY: 0001172940 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 314 BARSCHALL DR CITY: COLUMBUS STATE: GA ZIP: 31904-2202 MAIL ADDRESS: STREET 1: 314 BARSCHALL DR CITY: COLUMBUS STATE: GA ZIP: 31904-2202 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: AFLAC INC CENTRAL INDEX KEY: 0000004977 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] IRS NUMBER: 581167100 STATE OF INCORPORATION: GA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07434 FILM NUMBER: 03550067 BUSINESS ADDRESS: STREET 1: 1932 WYNNTON RD CITY: COLUMBUS STATE: GA ZIP: 31999 BUSINESS PHONE: 7063233431 MAIL ADDRESS: STREET 1: 1932 WYNNTON ROAD CITY: COLUMBUS STATE: GA ZIP: 31999 FORMER COMPANY: FORMER CONFORMED NAME: AMERICAN FAMILY CORP DATE OF NAME CHANGE: 19920306 5 1 spencer5123102.htm AFLAC INCORPORATED - FORM 5 Form 5

FORM 5

 

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

ANNUAL 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

  


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[   ] 

Check this box if no longer subject to
Section 16. Form 4 or Form 5 obli-
gations may continue. See Instruc-
tion 1(b).

 

  

[   ] 

Form 3 Holdings Reported

 

[   ] 

Form 4 Transactions Reported

 

1. Name and Address of Reporting Person*          




Spencer, Kathelen 

2. Issuer Name and Ticker or Trading Symbol

AFLAC INCORPORATED (AFL) 

6. Relationship of Reporting Person(s) to Issuer
                  (Check all applicable)

 

Director

 

10% Owner

 X

Officer (give
title below)

 

Other (specify
below)

Exec. Vice President 

(Last)                    (First)                (Middle)

314 Barschall Drive

3. I.R.S. Identification
   Number of Reporting
   Person, if an entity
   (Voluntary)

 

4. Statement for Month/Year

12/31/2002 


7. Individual or Joint/Group Reporting
              (check applicable line)

5. If Amendment, Date of
    Original (Month/Year)

 

  X 

Form Filed by One Reporting Person

(Street)

Columbus, GA 31904 

   

Form Filed by More than One Reporting Person

(City)                      (State)                  (Zip)

Table I ¾  Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security
    (Instr. 3)

2. Trans-
    action
    Date
   (Month/
    Day/
   Year)

2A. Deemed
      Execu-
      tion
      Date, if
      any
     (Month/
      Day/
      Year)

3. Trans-
    action
    Code
    (Instr.8)

4. Securities Acquired (A) or
    Disposed of (D)
    (Instr. 3, 4 and 5)

5. Amount of
    Securities Ben-
    eficially Owned
    at end of
    Issuer's Fiscal
    Year
    (Instr. 3 and 4)

6. Owner-
    ship
    Form: Di-
    rect (D)
    or Indi-
    rect (I)
    (Instr. 4)

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

Amount

  (A) or
  (D)

Price

Common Stock 

 

 

 

 

 

 

86,765

D

 

Common Stock 

12/31/02

 

I

31 (1)

A

 

5,658

I

401(K) Plan

Common Stock

 

 

 

 

 

 

1,800

I

Custodian/
Children

Common Stock

 

 

 

 

 

 

40,920

I

Partnership

Common Stock

 

 

 

 

 

 

 110,916

I

Spouse

Common Stock

 

 

 

 

 

 

 52,519

I

Spouse Cust/
Children

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*

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.

     

(Over)
SEC2270 (9-02)

 

 

FORM 5 (continued)

Table II ¾  Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative
    Security (Instr. 3)

2. Conver-
    sion or
    Exercise
    Price of
    Deriva-
    tive Sec-
    urity

3. Trans
    -action
    Date
   (Month/
    Day/
    Year)

3A. Deem
      -ed Ex-
      ecution
      Date, if
      any
     (Month/
       Day/
       Year)

4. Trans-
    action
    Code
    (Instr.8)

5. Number of Deriva-
    tive Securities Ac-
    quired (A) or Dis-
    posed of (D)
    (Instr. 3, 4 and 5)

6. Date Exercis-
    able and Expi-
    ration Date
    (Month/Day/
     Year)

7. Title and Amount of Underly-
    ing Securities
    (Instr. 3 and 4)

8. Price
    of
    De-
    riva-
    tive
    Secu-
    rity
 (Instr. 5)

9. Number
   of De-
   rivative
   Securi-
   ties Ben-
   eficially
   Owned
   at End of
   Year
   (Instr. 4)

10. Owner-
      ship of
      Deriva-
      tive Se-
      curity:
      Direct
      (D) or
      Indirect
      (I)
      (Instr. 4)

11. Nature of
     Indirect
     Benefi-
     cial
     Owner-
     ship
     (Instr. 4)

(A)

(D)

  Date
  Exer-
  cisable

  Expira-
  tion
  Date

Title

 Amount or
 Number of
 Shares

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explanation of Responses:

(1) Between May 30, 2002 and December 31, 2002, the reporting person acquired 31 shares of AFLAC Incorporated Common Stock under the AFLAC Incorporated
401(k) plan. The information in this report is based on a plan statement dated as of December 31, 2002. 

 

 

 

          

 

**

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).

By: Patricia A. Bell
For: Kathelen Spencer                                            

          

                                

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 required to respond unless the form displays a currently valid OMB Number.

                               

                                                   

Page 2

                                                                                      

             

SEC2270 (9-02)

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