-----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, V2T8O66ZcltilsJHNHFmCoob7XGozs/4nrGanT/3cLpFG2zlPvRHis/LsVtE5KKN +CFCnmFEhpBLdaZllJmfbw== 0000931763-97-002064.txt : 19971127 0000931763-97-002064.hdr.sgml : 19971127 ACCESSION NUMBER: 0000931763-97-002064 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19971014 FILED AS OF DATE: 19971126 SROS: NYSE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PHYSICIAN SUPPORT SYSTEMS INC CENTRAL INDEX KEY: 0000878760 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MANAGEMENT SERVICES [8741] IRS NUMBER: 133624081 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-20603 FILM NUMBER: 97729745 BUSINESS ADDRESS: STREET 1: RTE 230 EBY CHIQUES RD CITY: MT JOY STATE: PA ZIP: 17552 BUSINESS PHONE: 7176535340 MAIL ADDRESS: STREET 1: PO BOX 127 CITY: LANDISVILLE STATE: PA ZIP: 17538 COMPANY DATA: COMPANY CONFORMED NAME: NATIONAL DATA CORP CENTRAL INDEX KEY: 0000070033 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] OWNER IRS NUMBER: 580977458 STATE OF INCORPORATION: DE FISCAL YEAR END: 0531 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: NATIONAL DATA COPRORATION STREET 2: NATIONAL DATA PLAZA CITY: ATLANTA STATE: GA ZIP: 30329 BUSINESS PHONE: 4047282000 MAIL ADDRESS: STREET 1: NATIONAL DATA PLZ CITY: ATLANTA STATE: GA ZIP: 30329-2010 3 1 FORM 3 ---------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL WASHINGTON, D.C. 20549 OMB NUMBER:........3235-0104 Expires: September 30, 1998 - ---------- Estimated average burden FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES hours per response.......0.5 - ---------- ---------------------------- 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 (Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* | 2. Date of Event Requiring | 4. Issuer Name AND Ticker or Trading Symbol | Statement | Physician Support Systems, Inc. (PHSS) National Data Corporation | (Month/Day/Year) | - ------------------------------------------| 10/14/97 |----------------------------------------------------------- (Last) (First) (Middle) |-----------------------------| 5. Relationship of Reporting | 6. If Amendment, Date of | 3. IRS or Social Seurity | Person(s) to Issuer | Original Natonal Data Plaza | Number of Reporting | (Check all applicable) | (Month/Day/Year) - ------------------------------------------| Person (Voluntary) | __Director X 10% Owner |--------------------------- (Street) | 58-0977458 | __Officer __Other | 7. Individual or | | (give (specify | Joint/Group Filing | | title below) below) | (Check Applicable Line) | | | X Form filed by one Re- | | | porting Person | | | __Form filed by more than Atlanta, Georgia 30329-2010 | | | one Reporting Person - ------------------------------------------|----------------------------------------------------------------------------------------- (City) (State) (Zip) | Table I - Non-Derivative Securities Beneficially Owned - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security | 2. Amount of Securities | 3. Ownership Form: | 4. Nature of Indirect Beneficial Ownership (Instr. 4) | Beneficially Owned | Direct (D) or | (Instr. 5) | (Instr. 4.) | Indirect (I) | | | (Instr. 5) | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- Common Stock, $.001 Par Value | 0 | N/A/1/ | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- | | | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- | | | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- | | | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- | | | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- | | | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- | | | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- | | | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- | | | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- | | | - ---------------------------------------|--------------------------|--------------------|------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) *If the form is filed by more than one person, see Instruction 5(b)(v). SEC 1473 (7-96)
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security | 2. Date Exer- | 3. Title and Amount of Securities | 4. Conver- | 5. Owner- | 6. Nature of (Instr. 4) | cisable and | Underlying Derivative Security | sion or | ship | Beneficial | Expiration | (Instr. 4) | Exercise | Form of | Ownership | Date (Month/ | | Price of | Derivative | (Instr. 5) | Day/Year) | | Derivative| Security: | |-----------------|-----------------------------------| Security | Direct (D) | | Date | Expira-| Title | Amount or | | or Indirect| | Exer- | tion | | Number of | | (I) | | cisable| Date | | Shares | | (Instr. 5) | - --------------------------------|--------|--------|-----------------|-----------------|--------------|---------------|-------------- N/A |N/A |N/A |N/A |N/A |N/A | N/A |N/A - --------------------------------|--------|--------|-----------------|-----------------|--------------|---------------|-------------- | | | | | | | - --------------------------------|--------|--------|-----------------|-----------------|--------------|---------------|-------------- | | | | | | | - --------------------------------|--------|--------|-----------------|-----------------|--------------|---------------|-------------- | | | | | | | - --------------------------------|--------|--------|-----------------|-----------------|--------------|---------------|-------------- | | | | | | | - --------------------------------|--------|--------|-----------------|-----------------|--------------|---------------|-------------- | | | | | | | - --------------------------------|--------|--------|-----------------|-----------------|--------------|---------------|-------------- | | | | | | | - --------------------------------|--------|--------|-----------------|-----------------|--------------|---------------|-------------- | | | | | | | - --------------------------------|--------|--------|-----------------|-----------------|--------------|---------------|-------------- Explanation of Responses: 1 Pursuant to an Agreement and Plan of Merger, dated as of October 14, 1997 (the "Merger Agreement"), among National Data Corporation ("NDC"), Universal Acquisition Corp., a wholly-owned subsidiary of NDC, and Physician Support Systems, Inc. ("PSS"), NDC entered into a Stockholder Voting Agreement with certain PSS directors, executive officers and employees (the "Stockholders") who are, collectively, the beneficial owners of 2,869,581 shares of the Common Stock of PSS, or approximately 29.5% of the outstanding Common Stock of PSS, pursuant to which such Stockholders have agreed to vote in favor of approval of the Merger Agreement at every meeting of the stockholders of PSS at which such matters are considered and at every adjournment thereof and against a "Competing Transaction" (as such term is defined in the Stockholder Voting Agreement). NDC does not have a pecuniary interest in such shares and, therefore, disclaims any beneficial ownership thereof. NATIONAL DATA CORPORATION By: /s/ E. Michael Ingram 11/26/97 ** 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). 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. Page 2
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