-----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, Tsed4n28BH5pEP4zqiN2g7yFxoXf7jiCL9QiAHhZUpvoLWG12LUBjIy/8DyxLvIx M2B76EzraSkIUO9DspyYkA== 0001005788-02-000004.txt : 20021231 0001005788-02-000004.hdr.sgml : 20021231 20021231141644 ACCESSION NUMBER: 0001005788-02-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021227 FILED AS OF DATE: 20021231 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: ROLLINS GARY W CENTRAL INDEX KEY: 0001005788 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] RELATIONSHIP: OWNER IRS NUMBER: 510068479 STATE OF INCORPORATION: GA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 2170 PIEDMONT RD NE CITY: ATLANTA STATE: GA ZIP: 30324 MAIL ADDRESS: STREET 1: 2170 PIEDMONT ROAD NE CITY: ATLANTA STATE: GA ZIP: 30324 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ROLLINS INC CENTRAL INDEX KEY: 0000084839 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-TO DWELLINGS & OTHER BUILDINGS [7340] IRS NUMBER: 510068479 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-04422 FILM NUMBER: 02873615 BUSINESS ADDRESS: STREET 1: 2170 PIEDMONT RD NE CITY: ATLANTA STATE: GA ZIP: 30324 BUSINESS PHONE: 4048882000 MAIL ADDRESS: STREET 1: 2170 PIEDMONT ROAD NE CITY: ATLANTA STATE: GA ZIP: 30324 4 1 gwrform4a.txt GARY W. ROLLINS FORM 4 12/27/02 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 OMB APPROVAL ---------------------------- OMB Number: 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response.......0.5 FORM 4 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(h) of the Investment Company Act of 1940 [ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print or Type Responses) - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Rollins, Gary W. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 2170 Piedmont Road NE - -------------------------------------------------------------------------------- (Street) Atlanta, GA 30324 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Rollins, Inc. (ROL) - -------------------------------------------------------------------------------- 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Day/Year 12/27/02 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Day/Year) - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [X] Director [X] 10% Owner [X] Officer (give title below) [ ] Other (specify below) CEO, President, & Chief Operating Officer - -------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) [X] Form filed by One Reporting Person [ ] Form filed by More than One Reporting Person - -------------------------------------------------------------------------------- ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
5. Amount of 6. 2A. 4. Securities Owner- Deemed Securities Acquired (A) or Beneficially ship 2. Execution 3. Disposed of (D) Owned Form: 7. Transaction Date, Transaction (Instr. 3, 4 and 5) Following Direct Nature of Date if any Code ---------------------------- Reported (D) or Indirect 1. (Month/ (Month/ (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Day/ Day/ ----------- Amount or Price (Instr. 3 (I) Ownership (Instr. 3) Year) Year) Code V (D) and 4) (Instr. 4) (Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- Rollins, Inc. 12/27/02 G V 10,744 D 455,871** D Common Stock $1 Par Value - ----------------------------------------------------------------------------------------------------------------------------------- Rollins, Inc. 12/27/02 G V 754 A 70,323* I By Spouse Common Stock $1 Par Value - ----------------------------------------------------------------------------------------------------------------------------------- Rollins, Inc. 68,400* I Co-Trustee of Common Stock $1 Trusts Par Value - ----------------------------------------------------------------------------------------------------------------------------------- Rollins, Inc. 23,700* I Co-Trustee of Common Stock $1 Charitable Par Value Fund - ----------------------------------------------------------------------------------------------------------------------------------- Rollins, Inc. 10,419,000* I By LOR, Inc. Common Stock $1 Par Value - ----------------------------------------------------------------------------------------------------------------------------------- Rollins, Inc. 12/27/02 G V 5,012 A 382,264* I Trustee of Common Stock $1 Trust Par Value - ----------------------------------------------------------------------------------------------------------------------------------- Rollins, Inc. 595,000* I Co-Trustee of Common Stock $1 Charitable Par Value Foundation - ----------------------------------------------------------------------------------------------------------------------------------- Rollins, Inc. 432,000* I Rollins Common Stock $1 Holding Co., Par Value Inc. - ----------------------------------------------------------------------------------------------------------------------------------- Rollins, Inc. 1,359,000* I By Limited Common Stock $1 Liability Par Value Company - ----------------------------------------------------------------------------------------------------------------------------------- ===================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 4(b)(v). ** This number includes 13,512 shares of 401(k) stock first reported in January 2002. (Over) SEC 1474 (7/96) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
9. Number 10. of Owner- Deriv- ship 2. ative Form Conver- 5. 7. Secur- of 11. sion Number of Title and Amount ities Deriv- Nature or 3A. Derivative 6. of Underlying 8. Bene- ative of Exer- Deemed 4. Securities Date Securities Price ficially Secur- In- cise 3. Execu- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) or Owned ity: direct Price Trans- tion action or Disposed Expiration Date ---------------- Deriv- Following Direct Bene- 1. of action Date, Code of (D) (Month/Day/Year) Amount ative Reported (D) or ficial Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- Trans- Indirect Owner- Derivative ative (Month/ (Month/ 8) 4 and 5) Date Expira- Number ity action(s) (I) ship Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr, 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: /s/ Gary W. Rollins Signed by Glen P. Grove, Jr. As Power of Attorney December 31, 2002 - ------------------------------- ----------------------- **Signature of Reporting Person Date *Gary W. Rollins disclaims for the purpose of Section 16 of the Securities and Exchange Act of 1934, the beneficial ownership of the shares described in Table 1, lines 2-8, and this report is not an admission of such beneficial ownership. ** 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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2 CONFIRMING STATEMENT This Statement confirms that the undersigned, Gary W. Rollins, has authorized and designated Glenn P. Grove, Jr. to execute and file on the undersigned's behalf all Forms 3, 4, and 5 (including any amendments thereto) that the undersigned may be required to file with the U.S. Securities and Exchange Commission as a result of the undersigned's ownership of or transactions in securities of Rollins, Inc. The authority of Glenn P. Grove, Jr. under this Statement shall continue until the undersigned is no longer required to file Forms 3, 4, and 5 with regard to the undersigned's ownership of or transactions in securities of Rollins, Inc., unless earlier revoked in writing. The undersigned acknowledges that Glenn P. Grove, Jr. is not assuming any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934. /s/ Gary W. Rollins ------------------------------------ Gary W. Rollins -----END PRIVACY-ENHANCED MESSAGE-----