FORM 5 |
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 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). | |||||||||||||||||||||
Form 3 Holdings Reported. | |||||||||||||||||||||
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Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
EZ EM INC [ EZM ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 05/31/2003 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (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 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(1) | 10/21/2002 | 4J | 376,801 | A | 7.75 | 376,801 | D | ||||||||
Common stock(2) | 10/21/2002 | 4A | 1,000 | A | 7.75 | 377,801 | D | ||||||||
Common stock(3) | 10/21/2002 | 4J | 360,132.67 | A | 7.75 | 360,132.67 | I | Remainder interest | |||||||
Common stock(4) | 10/21/2002 | 4J | 213,889.01 | A | 7.75 | 213,889.01 | I | 22.55% interest in partnership's interest in 948,510 life estate shares | |||||||
Common stock(5) | 10/21/2002 | 4J | 165,977.02 | A | 7.75 | 165,977.02 | I | 22.55% interest in partnership's interest in 736,040 shares | |||||||
Common stock | 10/21/2002 | 4J | 1,909 | A | 7.75 | 1,909 | I | Shares owned by spouse | |||||||
Common stock(6) | 10/21/2002 | 4J | 67,533.91 | A | 7.75 | 67,533.91 | I | Spouse's 7.12% interest in partnership's interest in 948,510 life estate shares | |||||||
Common stock(7) | 10/21/2002 | 4J | 52,406.05 | A | 7.75 | 52,406.05 | I | Spouse's 7.12% interest in partnership's interest in 736,040 shares |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | ||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: 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 | |||||||||
Stock Options | 8.4 | 05/31/2003(8) | 4A | 1,000 | 05/31/2004 | 05/30/2013 | Common stock | 1,000 | $0(9) | 6,000 | D |
Explanation of Responses: |
1. All shares received on 10/21/2002 were received as a result of a capitalization effected by the Company on that date, in which each share of Class A and Class B common stock was converted automatically into one share of common stock, in a transaction exempt under Rule 16b-7. |
2. Acquired in compensation for services as a director of the Company. |
3. Represents shares in which Mr.Meyers owns a remainder interest, the life estate of which is held or measured by the life of his mother, Betty Meyers. |
4. Represents Mr. Meyers' 22.5% interest in the Meyers Family Limited Partnership's ("MFLP") life estate in 948,510 shares of common stock, as measured by the life of Betty Meyers. |
5. Represents Mr. Meyers' 22.55% interest in MFLP's ownership of 736,040 shares of common stock. |
6. Represents Mr. Meyers' wife's 7.12% interest in the MFLP's life estate in 948,510 shares of common stock, as measured by the life of Betty Meyers. |
7. Represents Mr. Meyers' wife's 7.12% interest in the MFLP's ownership of 736,040 shares of common stock. |
8. On May 31, 2003, Mr. Meyers received 1,000 options to purchase shares of common stock of the Company at $8.40 per share for services as a director of the Company. |
9. Director Services |
David P. Meyers | 07/15/2003 | |
** Signature of Reporting Person | Date | |
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). | ||
** 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 is insufficient, see Instruction 6 for procedure. | ||
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 Number. |