5 1 a32080.txt JACOB F.M. PETERS FORM 5 ---------------------------- OMB APPROVAL FORM 5 ---------------------------- OMB Number: 3235-0362 [ ] Check box if no longer subject to Expires: December 31, 2001 Section 16. Form 4 or Form 5 obligations Estimated average burden may continue. See Instruction 1(b). hours per response.....1.0 [ ] Form 3 Holdings Reported [ ] Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 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(f) of the Investment Company Act of 1940
--------------------------------------------------------------------- ----------------------------------------------------- 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol Peters, Jacob F.M. Pharmacia Corporation PHA --------------------------------------------------------------------- ----------------------------------------------------- (Last) (First) (Middle) 3. I.R.S. Identification 4. Statement for Number of Reporting Month/Year Person, if an entity December 2001 100 Route 206 North (Voluntary) --------------------------------------------------------------------- ---------------------- (Street) 5. If Amendment, Date of Original Peapack, NJ 07977 (Month/Year) --------------------------------------------------------------------------------------------------------------------------- (City) (State) (Zip)
------------------------------------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all Applicable) X Director 10% Owner -------- ------- Officer (give Other (specify -------- title below) ------- below) ------------------------------------------------------------- 7. Individual or Joint/Group Reporting (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 ------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) (Instr. 3) action action or Disposed of (D) Date Code (Instr. 3, 4 and 5) (Instr. 8) (Month/ ---------------------------------------------------------- Day/ Amount (A) or Price Year) (D) ------------------------------------------------------------------------------------------------------------------------ Common 04/17/2001 A 2,200 A $51.09 ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------- 5. Amount of 6. Ownership 7. Nature of Securities Form: Direct (D) Indirect Beneficially or Indirect (I) Beneficial Owned at (Instr. 4) Ownership end of Issuer's (Instr. 4) Fiscal Year (Instr. 3 and 4) ---------------------------------------------------------------------------------- 6,905 D ---------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- ----------------------------------------------------------------------------------
*If the form is filed by more than one reporting person, see instruction 4(b)(v). (Over) SEC 2270 (3-99) Page 1 of 3 FORM 5 (continued) Peters, Jacob F.M. - December 2001 Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of 6. Date Exercisable Security (Instr. 3) sion or action tion Code Derivative and Expiration Date Exercise Date (Instr. 8) Securities (Month/Day/Year) Price of Acquired (A) Derivative (Month/ or Disposed of Security Day/ (D) Year) (Instr. 3, 4, and 5) ------------------------------------------- (A) (D) Date Expi- Exercis- ration able Date ------------------------------------------------------------------------------------------------------------------ Option (right to buy) $44.25 (1) 11/21/2007 ------------------------------------------------------------------------------------------------------------------ Option (right to buy) $45.50 (1) 4/22/2009 ------------------------------------------------------------------------------------------------------------------ Option (right to buy) $52.81 (1) 6/22/2010 ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------ 7. Title and Amount of 8. Price of 9. Number of 10. Ownership 11. Nature Underlying Securities Derivative Derivative of Derivative of Indirect (Instr. 3 and 4) Security Securities Security: Beneficial (Instr. 5) Beneficially Direct (D) Ownership Owned at or Indirect (Instr. 4) End of (I) Year (Instr. 4) (Instr. 4) ------------------------ Title Amount or Number of Shares ----------------------------------------------------------------------------------------------------- Common 10,227 10,227 D ----------------------------------------------------------------------------------------------------- Common 6,462 6,462 D ----------------------------------------------------------------------------------------------------- Common 6,600 6,600 D ----------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------
Explanation of Responses: See attached statement **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. Don W. Schmitz 2/14/2002 -------------------------------- ----------------- ** Signature of Reporting Person Date Don W. Schmitz, attorney-in-fact for Jacob F.M. Peters Page 2 SEC 2270 (3-99) Page 2 of 3 Pharmacia Corporation PHA Form 5 - December 2001 Peters, Jacob F.M. 100 Route 206 North Peapack, NJ 07977 -------------------------------------------------------------------------------- Explanation of responses: (1) Option is currently exercisable. Page 3 of 3