3 1 0001.txt SAFEGUARD HEALTH ENTERPRISES U. S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Form 3 ------------------------------ OMB Number 3235-0104 Expires: December 31, 2001 Estimated average burden 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
------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person 2. Date of Event Re- 4. Issuer Name and Ticker or Trading Symbol quiring Statement John Hancock Financial Services, Inc. (Month/Day/Year) SafeGuard Health Enterprises ("SFGD") February 8, 2001 ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. IRS or Social Se- 5. Relationship of Reporting Person to Issuer 6. If Amendment, curity Number of (Check all applicable) Date of P.O. Box 111 Reporting Person _____ Director __X__ 10% Owner Original (Month/Day/Year) _________________________________________ (Voluntary) _____ Officer (give _____ Other (specify (Street) title below) below) 04-3483032 _______________________ 7. Individual or Joint/Group Filing (Check Applicable Line) X Form Filed by One --- Reporting Person Form Filed by More than Boston, MA 02117 --- One Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) Table 1 -- Non-Derivative Securities Beneficially Owned ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect (Instr. 4) Beneficially Owned Form: Direct Beneficial Ownership (Instr. 4) (D) or Indirect (Instr. 5) (I) (Instr.5) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 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 reporting person, see Instructions 5 (b) (v) SEC 1473 (3/99) Page 1 of 3 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 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) cisable and Securities Underlying sion or ship Beneficial Ownership Expiration Derivative Security Exercise Form of (Instr. 5) Date (Instr. 4) Price of Deri- (Month/Day/ Deri- vative Year) vative Security Security ----------------------------------------------- Date Expira- Amount Direct Exer- tion or (D) or cisable Date Title Number Indirect of (I) Shares (Instr. 5) ------------------------------------------------------------------------------------------------------------------------------------ Series B Preferred Stock Immed. Common Stock 3,015,385 (a) (b) (b) ------------------------------------------------------------------------------------------------------------------------------------ Series D Preferred Stock Immed. Common Stock 8,292,307 (a) (b) (b) ------------------------------------------------------------------------------------------------------------------------------------ Series B Preferred Stock Immed. Common Stock 492,308 (a) I Owned by JHVLIC (c) ------------------------------------------------------------------------------------------------------------------------------------ Series D Preferred Stock Immed. Common Stock 1,353,846 (a) I Owned by JHVLIC (c) ------------------------------------------------------------------------------------------------------------------------------------ Series B Preferred Stock Immed. Common Stock 123,077 (a) I Owned by IPL (d) ------------------------------------------------------------------------------------------------------------------------------------ Series D Preferred Stock Immed. Common Stock 338,462 (a) I Owned by IPL (d) ------------------------------------------------------------------------------------------------------------------------------------ Series B Preferred Stock Immed. Common Stock 369,231 (a) I By Bell Atlantic Master Trust ------------------------------------------------------------------------------------------------------------------------------------ Series D Preferred Stock Immed. Common Stock 1,015,384 (a) I By Bell Atlantic Master Trust ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (a) The Preferred shares owned are convertible into common stock at a ratio of 100 shares of common for each share of preferred. (b) Securities are owned directly by John Hancock Life Insurance Company ("JHLICO") a direct, wholly-owned subsidiary of John Hancock Financial Services, Inc. ("JHFS"). JHFS may be deemed the indirect beneficial owner of such securities. (c) John Hancock Variable Life Insurance Company ("JHVLIC") is a direct, wholly-owned subsidiary of John Hancock Life Insurance Company ("JHLICO"). (d) Investors Partner Life Insurance Company ("IPL") is a direct, wholly-owned subsidiary of John Hancock Variable Life Insurance Company. **Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). JOHN HANCOCK FINANCIAL SERVICES, INC. By:/s/Barry J. Rubenstein February 16, 2001 ------------------------------------- ----------------- Barry J. Rubenstein Date Vice President, Counsel, & Secretary 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 to respond unless the form displays a currently valid OMB control number. Page 2 of 3 SEC 1473 (3/99) Joint Filer Information ----------------------- Issuer Name and Trading Symbol: SafeGuard Health Enterprises (SFGD) Date of Event Requiring Statement: February 8, 2001 Designated Reporter: John Hancock Financial Services, Inc. 1. Name and address of Reporting Person: ------------------------------------- John Hancock Life Insurance Company 200 Clarendon Street Boston, MA 02117 IRS Number: 04-1414660 ---------- By: /s/Roger G. Nastou ------------------ Roger G. Nastou Vice President