-----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, Ij7so80BRYpJxpHYlHahZSkajKdLYDz8Grv13g3hVSRW8UvuKPlBAFRiwzh0jbGl 65yUs+wp1eiSixnI67KrEw== 0000910680-03-000006.txt : 20030106 0000910680-03-000006.hdr.sgml : 20030106 20030106142416 ACCESSION NUMBER: 0000910680-03-000006 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030103 FILED AS OF DATE: 20030106 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: SHAMASH YACOV/NY CENTRAL INDEX KEY: 0001158348 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 100 ENGINEERING STREET 2: STATE OF UNIVERSITY OF NEW YORK CITY: STONE BROOK STATE: NY ZIP: 117942200 MAIL ADDRESS: STREET 1: 100 ENGINEERING STREET 2: STATE UNIVERSITY OF NY CITY: STONE BROOK STATE: NY ZIP: 117942200 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: AMERICAN MEDICAL ALERT CORP CENTRAL INDEX KEY: 0000700721 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS BUSINESS SERVICES [7380] IRS NUMBER: 112571221 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08635 FILM NUMBER: 03504699 BUSINESS ADDRESS: STREET 1: 3265 LAWSON BLVD CITY: OCEANSIDE STATE: NY ZIP: 11572 BUSINESS PHONE: 5165365850 MAIL ADDRESS: STREET 1: 3265 LAWSON BLVD CITY: OCEANSIDE STATE: NY ZIP: 11572 4 1 form4yshamash010303.txt FORM 4 - YACOV SHAMASH - 1/3/2003] ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response ....... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 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 [ ] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Shamash Yacov - -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o American Medical Alert Corp. 3265 Lawson Boulevard - -------------------------------------------------------------------------------- (Street) Oceanside NY 11572 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol American Medical Alert Corp. ("AMAC") - -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Day/Year 1/03/03 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [ ] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) - -------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (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 ================================================================================
6. 4. 5. Owner- 2A. Securities Acquired (A) or Amount of ship Deemed 3. Disposed of (D) Securities Form: 7. Execution Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Date, if Code -------------------------- Owned at End (D) or Indirect 1. Transaction any (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date (mm/dd/yy) ----------- Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 01/03/03 P 2,000 A $2.42 2,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Page 1 of 2 (Over) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. 6. Deriv- of Conver- 5. Date 7. ative Deriv- 11. sion Number of Exercisable Title and Amount Secur- ative Nature or Derivative and of Underlying 8. ities Secur- of Exer- 4. Securities Expiration Date Securities Price Bene- ity: In- cise 3. 3A. Trans- Acquired (A) (Month/Day/Year) (Instr. 3 and 4) of ficially Direct direct Price Trans- Deemed action or Disposed ---------------- ---------------- Deriv- Owned (D) or Bene- 1. of action Execution Code of(D) Amount ative at End In- ficial Title of Deriv- Date Date, if (Instr. (Instr. 3, or Secur- of direct Owner- Derivative ative (Month/ any 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ (Month/Day ------ ----------- Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $2.30 8/13/02 A 10,000 Immed. 8/12/12 Stock 10,000 10,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $1.90 Immed. 10/29/06 Stock 10,000 10,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: /s/ Yacov Shamash 1/6/03 - --------------------------------------------- ------------------- **Signature of Reporting Person Date Yacov Shamash * If the form is filed by more than one reporting person, see Instruction 4(b)(v). ** 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. Page 2 of 2 -----END PRIVACY-ENHANCED MESSAGE-----