5 1 c67477ae5.txt FORM 5 ------ FORM 5 ------ / / Check box if no UNITED STATES SECURITIES AND EXCHANGE COMMISSION longer subject to WASHINGTON, DC 20549 Section 16. Form 4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP obligations may continue. See Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Instruction 1(b) Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 / / Form 3 Holdings Reported / / Form 4 Transactions Reported ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer (Check all applicable) X Director X 10% Owner ---- --- X Officer (give Other (Specify ---- title --- below) Patterson, Neal L Cerner Corporation (CERN) below) Chairman and CEO ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. IRS Identification 4. Statement for 7. Individual or Joint/Group Filing Number of Reporting Month/Year (Check applicable line) Person, if an Entity X Form filed by One Reporting (Voluntary) December 29, 2001 ---- Person 2800 Rockcreek Parkway Form Filed by More Than One ------------------------------------------- ------------------- ---- Reporting Person (Street) 5. If Amendment, Kansas City, MO 64117-2551 Date of Original ------------------------------------------- (Month/Year) (City) (State) (Zip) ------------------------------------------------------------------------------------------------------------------------------------ TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature (Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In- Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct (Instr. 8) End of Issuer's Direct Benefi- (Month/ Fiscal Year (D) or cial Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner- Year) Amount (A) or (D) Price (I) ship (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3,191,752 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 32,176 I by Spouse ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/29/01 J 308 A (1) 238,656 I by Trust ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ *If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). Page 1 of 3 pages (Over) 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 control number. SEC 2270 (3-99)
FORM 5 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price Security sion or action action Derivative cisable and of Underlying of (Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv- Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative Deriv- Day/ Disposed of (D) (Month/Day/ Secur- ative Year) (Instr. 3, 4, Year) ity Security and 5) (Instr. 5) ----------------------------------- Date Expira- Amount or --------------- Exer- tion Title Number of (A) (D) cisable Date Shares ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Common Option (right to buy) $43.29000 06/14/01 A 30,000 06/14/11 Stock 30,000 ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Common Option (right to buy) $43.29000 06/14/01 A 7,500 06/14/11 Stock 7,500 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 9. Number of 10. Ownership 11. Nature of Derivative of Derivative Indirect Securities Security: Beneficial Beneficially Direct (D) Ownership Owned at End or Indirect (I) (Instr. 4) of Year (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------- D ------------------------------------------------------------------------------------------------------- 37,500 D ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- Explanation of Responses: See continuation page(s) for footnotes /s/ Neil L. Patterson 2-12-02 ------------------------------- ------- **Signature of Reporting Person Date ** 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. Potential persons who are to respond to the collection of information contained in this form Page 2 of 3 pages Page 2 are not required to respond unless the form displays a currently valid OMB Number. SEC 2270 (3-99)
Patterson, Neal L Cerner Corporation (CERN) 2800 Rockcreek Parkway December 31, 2001 Page 3 of 3 pages Kansas City, MO 64117-2551 (1) Acquired shares held in issuer's 401(K) Trust, not required to be reported earlier, were acquired at various dates and at various prices during the year.