3 1 0001.txt FORM 3 -------------- FORM 3 -------------- U. S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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. Date of Event Requiring 4. Issuer Name and Ticker or Trading Symbol Reporting Person* Statement (Month/Day/Year) November 10, 2000 LabOne, Inc. ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. IRS or Social Security Number 5. Relationship of Reporting Person to 6. If Amendment, Date of of Reporting Person Issuer (Check all applicable) Original Asselta, Michael J. (Voluntary) (Month/Day/Year) __Director __10% Owner X Officer __Other (give title below) (specify below) Executive Vice President, Operations ----------------------------- ------------------------ (Street) 7. Individual or Joint/ Group Filing (Check 12906 Carter Street applicable Line) X Form filed by One Reporting Person __ Form filed by More than One Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) Table 1 - Non-Derivative Securities Beneficially Owned Overland Park, Kansas 66213 ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of 3. Ownership 4. Nature of Indirect Securities Form: Direct Beneficial Ownership Beneficially Owned (D) or Indirect (Instr. 5) (Inst. 4) (I) (Instr. 5) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,314 D(1) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ * If the Form is filed by more than one Reporting Person, see instruction 5(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 PAGES (Table Continued) FORM 3 (cont'd.) Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of 2. Date exer- 3. Title and 4. Conver- 5. Ownership 6. Nature of Derivative cisable and Amount of sion or Form of Indirect Security Expiration Securities Exercise Derivative Beneficial (Inst. 4) Date (Month/ Underlying Price of Security: Ownership Day/Year) Derivative Derivative Direct (d) (Instr. 5) Security Security or Indirect (Inst. 4) (I) (Instr. 5) -------------------------------------------------- Date Expira- Amount Exer- Tion Title or Number cisable Date of Shares ------------------------------------------------------------------------------------------------------------------------------------ Employee Longterm Incentive 05/12/2000 05/12/2005 Common Stock 2,500 $13.7500 D Stock Plan (05/10/95) ------------------------------ ---------------------------------------------------- Employee Longterm Incentive 11/10/2000 11/10/2005 Common Stock 17,500 $11.6250 D Stock Plan (11/10/95) ------------------------------ ---------------------------------------------------- Employee Longterm Incentive 05/14/2004 05/14/2009 Common Stock 10,000 $12.1719 Stock Plan (05/14/99) ------------------------------ ---------------------------------------------------- ------------------------------ ---------------------------------------------------- ------------------------------ ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: (1) All of which are held in an individually directed account under LabOne's 401(k) profit-sharing plan, as to which Mr. Asselta has sole investment power only. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). /s/ Michael J. Asselta 11/21/00 -------------------------- ------------------- Michael J. Asselta by Randy Date Shelton as attorney-in-fact 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 PAGES