-----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, CNHiGE9ZtSHMg3vdLDo7CT6sNMaciRIcxROijbNVMaC1uk55p1EMwtHKt10i1thU c4LjFgkHW/FneuD7AoXXjQ== 0001011438-98-000041.txt : 19980218 0001011438-98-000041.hdr.sgml : 19980218 ACCESSION NUMBER: 0001011438-98-000041 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19971231 FILED AS OF DATE: 19980217 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: VETERINARY CENTERS OF AMERICA INC CENTRAL INDEX KEY: 0000817366 STANDARD INDUSTRIAL CLASSIFICATION: AGRICULTURE SERVICES [0700] IRS NUMBER: 954097995 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-19935 FILM NUMBER: 98543625 BUSINESS ADDRESS: STREET 1: 3420 OCEAN PARK BLVD STE 1000 CITY: SANTA MONICA STATE: CA ZIP: 90405 BUSINESS PHONE: 3103929599 MAIL ADDRESS: STREET 1: 3420 OCEAN PARK BLVD STE 1000 CITY: SANTA MC STATE: CA ZIP: 90405 COMPANY DATA: COMPANY CONFORMED NAME: FULLER TOMAS W CENTRAL INDEX KEY: 0001036185 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: VETERINARY CENTER OF AMERICA INC STREET 2: 3420 OCEAN PARK BLVD., SUITE 1000 CITY: SANTA MONICA STATE: CA ZIP: 90405 BUSINESS PHONE: 3103929599 5 1 FORM 5 [ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. SEE Instruction 1(b). [ ] Form 3 Holdings Reported [ ] Form 4 Transactions Reported U.S. 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, 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* Last: Fuller Street: 3420 Ocean Park Boulevard, Suite 1000 First: Thomas City: Santa Monica Middle: W. State: California Zip: 90405 2. Issuer Name and Ticker or Trading Symbol Veterinary Centers of America (VCAI) 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year December 1997 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director --- [ ] 10% Owner --- [X] Officer (give title below) --- [ ] Other (specify below) --- Vice President, Chief Financial Officer --------------------------------------- 7. Individual or Joint/Group Filing (Check applicable line) Form Filed by one Reporting Person --- Form Filed by more than one Reporting Person --- 1. Title of Security 2. Trans- 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of (Instr. 3) action Code or Disposed of (D) Securities Form; Indirect Date (Instr. 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Beneficial (Month/ Owned at End or Indirect Ownership Day/ Amt. (A) or Price of Issuer's (I) (Instr. 4) Year) (D) Fiscal Year (Instr. 4) (Instr. 3 and 4)
TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) (Over) FORM 5 (CONTINUED) 1.Title 2.Conver- 3.Trans- 4.Trans- 5.No. of 6.Date Exer- 7.Title and 8.Price 9.No. of 10.Owner- 11.Nature of sion or action action Deriv- cisable Amt. of of Deriv- ship of In- Deri- Exercise Date Code ative and Ex- Underly- Deri- ative of Deri- direct vative Price of (Month/ (Instr.8) Securi- piration ing Secur- vative Securi- vative Benefi- Security Deriva- Day/ ties Ac- Date (Month/ ities Security ties Security: cial (Instr.3) tive Year) quired Day/Year) (Instr.3 (Instr.5) Benefi- Direct(D) Owner- Security (A) or and 4) cially or Indi- ship Disposed Owned rect(I) (Instr. of (D) at End (Instr.4) 4) (Instr.3 of Year 4, and 5) (Instr.4) (A) (D) Date Expira- Title Amt or Exer- tion No. of cis Date Shares able Stock Option $10.25 2-3-97 A 315,000 (1) 2-3-07 Common 315,000 510,667 D (right to buy) Stock
TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
Explanation of Responses: (1) The options vest in 54 equal monthly installments beginning on September 1, 1997. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). /s/ Tom Fuller February 16, 1998 --------------------------- --------------- **Signature of Reporting Person Date 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
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