-----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, Tn3VbaVvK5h6bSYAHjQvdB7L9bNSGFsmmWSQ3sQ4B2IMn12iPq75omsIe8wyD0ZL 2qzqIE+W8IVp48jzsbg6Qw== 0001014108-00-000043.txt : 20000215 0001014108-00-000043.hdr.sgml : 20000215 ACCESSION NUMBER: 0001014108-00-000043 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991231 FILED AS OF DATE: 20000214 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: LABONE INC/ CENTRAL INDEX KEY: 0000830158 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 431039532 STATE OF INCORPORATION: MO FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-16946 FILM NUMBER: 543556 BUSINESS ADDRESS: STREET 1: 10101 RENNER BLVD STREET 2: P. O. BOX 7568 CITY: LENEXA STATE: KS ZIP: 66219 BUSINESS PHONE: 9136483600 MAIL ADDRESS: STREET 1: 5000 W 95TH STREET STREET 2: SUITE 260 CITY: SHAWNEE MISSION STATE: KS ZIP: 66207 FORMER COMPANY: FORMER CONFORMED NAME: LAB HOLDINGS INC DATE OF NAME CHANGE: 19980406 FORMER COMPANY: FORMER CONFORMED NAME: SEAFIELD CAPITAL CORP DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: BMA CORP /MO/ DATE OF NAME CHANGE: 19910520 COMPANY DATA: COMPANY CONFORMED NAME: GRANT THOMAS W II CENTRAL INDEX KEY: 0001036337 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: C/O LABONE INC STREET 2: 10310 W 84TH TERRACE PO BOX 2035 CITY: LENEXA STATE: KS ZIP: 66214 MAIL ADDRESS: STREET 1: LABONE INC STREET 2: 10310 W 84TH TERRACE PO BOX 2035 CITY: LENEA STATE: KS ZIP: 66214 5 1 ANNUAL STMT OF CHANGES IN BENEFICIAL OWNERSHIP
U. S. SECURITIES AND EXCHANGE COMMISSION FORM 5 [ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. Washington, D.C. 20549 See instruction 1(b). [ ] Form 3 Holdings Reported. ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP [ ] Form 4 Transactions Reported. 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 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Reporting Person* Issuer (Check all applicable) LabOne, Inc. (LABS) X Director ___ 10% Owner - -------------------------------------------------------------------------------- --- (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for X Officer ___ Other Number of Reporting Month/Year --- (give title (specify Grant II, W. Thomas Person (Voluntary) 12/1999 below) below) Chairman of the Board of Directors, President, Chief Executive Officer and Class C Director - ------------------------------- ---------------------------------------------------------------------- (Street) 5. If Amendment, Date of 7. Individual or Joint/Group Filing Original (Month/Year (Check applicable line) X Form filed by One Reporting 10101 Renner Boulevard --- Person ___ Form filed by More than One Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) Table 1 - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned. Leawood, Kansas 66219 - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of (Instr. 3) action action or Disposed of (D) Securities Form: Indirect date: Code (Instr. 3, 4 and 5) Beneficially Direct Beneficial (Month/ (Instr. 8) Owned at (D) or Ownership Day/ End of Issuer's Indirect (Instr. 4) Year) Fiscal Year. (I) (Instr. 3 (Instr. 4) and 4) ------------------------- Amount (A) or Price (D) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12,793 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 63,823 I (1) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ * 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) Page 1 of 2 FORM 5 (continued) Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ==================================================================================================================================== 1.Title of 2.Conver- 3.Trans- 4.Transac- 5.Number of 6.Date 7.Title 8.Price of 9.Number 10.Owner- 11.Nature Derivative sion or action tion Code Derivative Exercisable and Amount Derivative of Deriv- ship of In- Security Exercise Date (Instr. 8) Securities and of Security ative Form of direct (Inst. 3) Price of (Month/ Acquired Expiration Underlying (Instr. 5) Securities Deriv- Bene- Deriv- Day/ (A) or Date Securities Beneficial- ative ficial ative Year) Disposed (Month/Day/ (Instr. 3 ly Owned at Security; Owner- Security of (D) Year) and 4) End of Direct ship (Instr.3, Month (D) or (Instr 4, and 5) (Instr. 4) Indirect 4) (I) (Instr. 4) ------------------------------------------ (A) (D) Date Expira- Title Amount or Exer- tion Date Number of cisable Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== Explanation of Responses: Includes (a) 35,923 shares of common stock held by Mr. Grant as custodian for his children; (b) 2,473 shares owned by Mr. Grant's wife as to which Mr. Grant disclaims beneficial ownership; and (c) 25,427 shares of common stock held in an individually directed acount under LabOne's 401(k) profit-sharing plan, as to which Mr. Grant has sole investment power only. Excludes 67,500 shares held in a family trust for which Mr. Grant serves as a co-trustee and in that capacity shares voting and investment powers, but has no pecuniary interest. /s/ W. Thomas Grant II by Randy Shelton as attorney-in-fact February 14, 2000 ----------------------------------------------------------- ---------------- ** W. Thomas Grant II by Randy Shelton as attorney-in-fact 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 provided is insufficient, see Instruction 6 for procedure. Page 2 of 2
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