-----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, WrL5GrB41nQB/Y/moDvCloOrYtV3jl+SSIH8DFx2x7tTGXvr62Gha5meePsPl4hb B3LeV6w0Hy84k2Fr7lCxKg== 0001159937-02-000001.txt : 20020513 0001159937-02-000001.hdr.sgml : 20020513 ACCESSION NUMBER: 0001159937-02-000001 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020513 FILED AS OF DATE: 20020513 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MENTOR CORP /MN/ CENTRAL INDEX KEY: 0000064892 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 410950791 STATE OF INCORPORATION: MN FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-07955 FILM NUMBER: 02643517 BUSINESS ADDRESS: STREET 1: 201 MENTOR DR CITY: SANTA BARBARA STATE: CA ZIP: 93111 BUSINESS PHONE: 8058796000 MAIL ADDRESS: STREET 1: 201 MENTOR DR CITY: SANTA BARBARA STATE: CA ZIP: 93111 COMPANY DATA: COMPANY CONFORMED NAME: SHEPARD PETER CENTRAL INDEX KEY: 0001159937 OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 201 MENTOR DRIVE CITY: SANTA BARBARA STATE: CA ZIP: 93111 BUSINESS PHONE: 8058796000 5 1 form5shepard.htm FORM 5 FOR PETER SHEPARD Form 5 - Courtesy of e-Services, LLC - www.edgar2.net

 

Form 5

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

__ Form 3 Holdings Reported

_X_ Form 4 Transactions Reported

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549


ANNUAL STATEMENT OF CHANGES 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

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1.  Name and Address of Reporting Person*

Shepard, Peter

2.  Issuer Name and Tickler or Trading Symbol

Mentor Corporation ("MNTR")

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

___ Director                                  ___ 10% Owner
_X__ Officer (give title below)        ___ Other (specify below)
VP, Sales and Marketing, Urology

(Last)         (First)        (Middle)

201 Mentor Drive

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

 

4.  Statement for Month/Year

March 2002

(Street)

Santa Barbara, CA 93111

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

 

7.  Individual or Joint/Group Reporting
            (check applicable line)
_X__ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person

(City)     (State)      (Zip)

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

1. Title of Security
    (Instr. 3)

2.Transaction Date
   (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 at the end of Issuer's Fiscal Year 
(Instr. 3 and 4)

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

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

Amount

(A) or (D)

Price

Common Stock 2/7/02 M (4) 8,000 A 5.56    D   
Common Stock 2/7/02 S (4) 8,000 D 34.50   D  
            10,200    

* If the form is filed by more than one reporting person, see instruction 4(b)(v).


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

4.Trans-
   action
   Code
   (Instr. 8)

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

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 at End
   of Year
   (Instr. 4)

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

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

(A)

(D)

Date Exercisable

Expiration Date

Title

Amount or Number of Shares

Option (Right to Buy)

 26.61 5/23/01

  

 A

  

 5/23/02 5/23/11 Common Stock 7,500

  

  

  D

  

  

 26.61 5/23/01

  

 A

  

 5/23/03 5/23/11

Common Stock  

 7,500

  

  

  D

  

  

 26.61 5/23/01

  

 A

  

 5/23/04 5/23/11

Common Stock

7,500

  

  

  D

  

  

26.61  

 5/23/01

  

 A

  

 5/23/05 5/23/11 Common Stock 7,500

  

  

  D

  

  

  

  

  

  

  

  

  

  

  

  

 125,000

  

  

Explanation of Responses: Table II - above is grant of 30,000 shares pursuant to Mentor 1991 Stock Plan during fiscal 2002.

/S/ADEL MICHAEL
**Signature of Reporting Person

May 13, 2002
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 provided is insufficient, see Instruction 6 for procedure.

 

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