-----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, RCLkRzOhJsOdDE256hmGEq6ptda9uKTOxUOKktccMK6cdMUlCzStQMmcK4Mfhlcp dLcZuXa6yiioZ6Bdy4lIMw== 0000004977-03-000114.txt : 20030430 0000004977-03-000114.hdr.sgml : 20030430 20030429173403 ACCESSION NUMBER: 0000004977-03-000114 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030428 FILED AS OF DATE: 20030430 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07434 FILM NUMBER: 03670422 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 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: AMOS DANIEL P CENTRAL INDEX KEY: 0001075275 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 1932 WYNNTON ROAD CITY: COLUMBUS STATE: GA ZIP: 31999 BUSINESS PHONE: 7065963499 MAIL ADDRESS: STREET 1: 1932 WYNNTON ROAD CITY: COLUMBUS STATE: GA ZIP: 31999 4 1 damos.htm FORM 4 Form 4 - AFLAC Incorporated

FORM 4

 

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

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 obligations may continue.
See Instruction 1(b).

 

  

 

(Print or Type Responses)

1. Name and Address of Reporting Person*          




 Amos, Daniel P

2. Issuer Name and Ticker or Trading Symbol

 AFLAC INCORPORATED (AFL)

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

X

Director

 

10% Owner

 X

Officer (give
title below)

 

Other (specify
below)

Chairman of the Board
Chief Executive Officer 

(Last)                    (First)                (Middle)


 P.O. Box 5566

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

 

4. Statement for
    Month/Day/Year

04/28/03 



7. Individual or Joint/Group Filing (Check Applicable Line)

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

 

   X

Form filed by One Reporting Person


Columbus, GA 31906

   

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
Execution
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
    Beneficially
    Owned
    Following
    Reported
    Transaction(s)

    (Instr. 3 and 4)

6. Owner-
    ship
    Form:
    Direct
    (D) or
    Indirect
    (I)

  (Instr. 4)

7. Nature of
    Indirect
    Beneficial
    Owner-
    ship



   (Instr. 4)

Code

V

Amount

(A)
or
(D)

Price

 Common Stock

04/28/03

 

G

V

200

D

 

1,337,845

D

 

 Common Stock

 

 

 

 

 

 

 

 5,667,063

I

Partnership

 Common Stock

 

 

 

 

 

 

 

 248,996

I

Spouse

 Common Stock

 

 

 

 

 

 

 

 441,105

I

Spouse TTEE Children

 Common Stock

 

 

 

 

 

 

 

 95,100

I

TTEE/
Children

 Common Stock

 

 

 

 

 

 

 

 617,087

I

Trust

 

 

 

 

 

 

 

 

 

 

 

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.

     

(Over)
SEC 1474 (9-02)

FORM 4 (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
    Deri-
    vative
   Security

3. Trans-
    action
    Date

(Month/
 Day/
Year)

3A.
Deemed
Execution
Date, if
any

  (Month/
   Day/
  Year)

4. Trans-
    action
    Code
    (Instr.8)

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

6. Date Exer-
    cisable and
    Expiration
    Date
    (Month/Day/
    Year)

7. Title and Amount of
    Underlying Securities
    (Instr. 3 and 4)

8. Price
    of
    Deriv-
    ative
    Secur-
    ity
    (Instr.
    5)

9. Number
   of deriv-
   ative
   Secur-
   ities
   Bene-
   ficially
   Owned
   Follow-
   ing
   Reported
   Trans-
   action(s)
   (Instr. 4)

10. Owner-
     ship
     Form of
     Deri-
     vative
     Security:
     Direct
     (D) or
     Indirect
     (I)
     (Instr. 4)

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

Code

V

(A)

(D)

Date
Exer-
cisable

Expira-
tion
Date

Title

Amount or
Number of
Shares

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explanation of Responses:

 

 

 

 

          

 

**

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: Daniel P. Amos                        

          

      04/29/03                          

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

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