-----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, Pk4G8elGWwmLpwP6WmXEH8m2+1PcyVsevR//L/ILPA6kF0gh7A6vBEB5j9nsP4sF Y1eD9W0HH9yWAds8o38m0g== 0001010521-01-000156.txt : 20010224 0001010521-01-000156.hdr.sgml : 20010224 ACCESSION NUMBER: 0001010521-01-000156 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010208 FILED AS OF DATE: 20010216 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SAFEGUARD HEALTH ENTERPRISES INC CENTRAL INDEX KEY: 0000727303 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 521528581 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-12050 FILM NUMBER: 1549085 BUSINESS ADDRESS: STREET 1: 95 ENTERPRISE T CITY: ALISO VIEJO STATE: CA ZIP: 92656-2601 BUSINESS PHONE: 9494254110 COMPANY DATA: COMPANY CONFORMED NAME: HANCOCK JOHN FINANCIAL SERVICES INC CENTRAL INDEX KEY: 0000736260 STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311] OWNER IRS NUMBER: 043483032 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: LAW DIVISION STREET 2: PO BOX 111 CITY: BOSTON STATE: MA ZIP: 02117 MAIL ADDRESS: STREET 1: LAW DIVISION STREET 2: PO BOX 111 CITY: BOSTON STATE: MA ZIP: 02117 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
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