-----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, Gm+TJ9zNSUrgNkaoZIxjwyISN1jOqah4QWQ/f0/eS5tJ+wRRO0LaVrx/Naf+UslF X7CE713tCQ7zcis8f9un1g== 0001014108-01-000039.txt : 20010224 0001014108-01-000039.hdr.sgml : 20010224 ACCESSION NUMBER: 0001014108-01-000039 CONFORMED SUBMISSION TYPE: 5/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001231 FILED AS OF DATE: 20010222 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/A SEC ACT: SEC FILE NUMBER: 333-92137 FILM NUMBER: 1551739 BUSINESS ADDRESS: STREET 1: 10101 RENNER BLVD STREET 2: P. O. BOX 7568 CITY: LENEXA STATE: KS ZIP: 66219 BUSINESS PHONE: 9138881770 MAIL ADDRESS: STREET 1: 10101 RENNER BLVD STREET 2: X CITY: LENEXA STATE: KS ZIP: 66219 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 WILLIAM D CENTRAL INDEX KEY: 0000901157 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] OWNER STATE OF INCORPORATION: MO FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5/A BUSINESS ADDRESS: STREET 1: SEAFIELD CAPITAL CORPORATION STREET 2: 2600 GRAND AVENUE STE 500 CITY: KANSAS CITY STATE: MO ZIP: 64108 BUSINESS PHONE: 8168427000 MAIL ADDRESS: STREET 1: SEAFIELD CAPITAL CORP STREET 2: 2600 GRAND AVENUE SUITE 500 CITY: KANSAS CITY STATE: MO ZIP: 64108 5/A 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 03/31/2000 J(1) 13,808 A - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 06/01/2000 A 1,927 A - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 06/30/2000 J(1) 16,264 A - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 06/01/2000 J(1) 5,368 A - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/31/2000 J(1) 8,444 A - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/31/2000 G 1,000 D 915,972(2) D - ------------------------------------------------------------------------------------------------------------------------------------ 847,371 I (3) * 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) 21,942 shares were distributed to Mr. Grant and 21,942 shares were distributed to Mr. Grant's wife by four charitable remainder trusts of which Mr. and Mrs. Grant are beneficiaries; (2) Includes 22,000 shares which Mr. Grant has the right to acquire within 60 days pursuant to exercisable stock options; and (3) 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) 73,976 shares owned by Mr. Grant's wife, as to which Mr. Grant disclaims beneficial ownership. Does not include 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 pecuniary interest. /s/ William D. Grant by Randy Shelton as attorney-in-fact February 21, 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
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