5 1 0001.txt 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 X 10% Owner -------------------------------------------------------------------------------- --- --- (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for Officer ___ Other Number of Reporting Month/Year --- (give title (specify Grant, W. D. Person (Voluntary) 12/2000 below) below) ------------------------------- ---------------------------------------------------------------------- (Street) 5. If Amendment, Date of 7. Individual or Joint/Group Filing Original (Month/Year (Check applicable line) X Form filed by One Reporting One Ward Parkway, Suite 130 --- Person ___ Form filed by More than One Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) Table 1 - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned. Kansas City, Missouri 64112 ------------------------------------------------------------------------------------------------------------------------------------ 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 6/01/2000 A 1,927 A 122,369 D 1,576,090 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: (1) Includes (a) 478,237 shares held by three family trusts for which Mr. Grant, as co-trustee, shares voting and investment power with UMB Bank, N.A.; (b) 295,158 shares held by two family trusts as to which Mr. Grant has the right to direct the voting and disposition of such shares and therefore shares voting and investment powers with the trustee, UMB Bank, N.A. and (c) 52,034 shares owned by Mr. Grant's wife, as to which Mr. Grant disclaims beneficial ownership. Does not inlcude 60,649 shares held by a family trust for Mr. Grant's niece, for which Mr. Grant, as co-trustee, shares voting and investment power with UMB Bank, N.A., as to which shares Mr. Grant does not have a penuniary interest. /s/ William D. Grant by Randy Shelton as attorney-in-fact February 14, 2001 --------------------------------------------------------- ----------------- William D. Grant 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