-----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, LXTYrJdGBF+ZKtozpp+yhAcIXi8/LVmf5yjifaYKhBaRs6hBaQtOx8fjH53DH1lz 5D7phwPPoyY0WkmC9FD/pQ== 0000912057-96-018640.txt : 19960826 0000912057-96-018640.hdr.sgml : 19960826 ACCESSION NUMBER: 0000912057-96-018640 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19960823 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: STERICYCLE INC CENTRAL INDEX KEY: 0000861878 STANDARD INDUSTRIAL CLASSIFICATION: HAZARDOUS WASTE MANAGEMENT [4955] IRS NUMBER: 363640402 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21229 FILM NUMBER: 96619502 BUSINESS ADDRESS: STREET 1: 1419 LAKE COOK RD STREET 2: SUITE 410 CITY: DEERFIELD STATE: IL ZIP: 60015 BUSINESS PHONE: 8479456550 MAIL ADDRESS: STREET 1: 1419 LAKE COOK RD STREET 2: STE 410 CITY: DEERFIELD STATE: IL ZIP: 60015 COMPANY DATA: COMPANY CONFORMED NAME: POLARK JAMES F CENTRAL INDEX KEY: 0001021415 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 1419 LAKE COOK ROAD SUITE 410 CITY: DEERFIELD STATE: IL ZIP: 60015 BUSINESS PHONE: 8479456550 3 1 FORM 3
- -------- U.S. SECURITIES AND EXCHANGE COMMISSION ----------------------------- FORM 3 WASHINGTON, D.C. 20549 OMB APPROVAL - -------- ----------------------------- INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES OMB NUMBER: 3235-0104 EXPIRES: APRIL 30, 1997 Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 0.5 Section 30(f) of the Investment Company Act of 1940 ----------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person 2. Date of Event Re- 4. Issuer Name and Ticker or Trading Symbol quiring Statement Polark James F (Month/Day/Year) Stericycle, Inc. (SRCL) - ------------------------------------------------- ------------------------------------------------------------ (Last) (First) (Middle) 8/22/96 5. Relationship of Reporting Person 6. If Amendment, Date ----------------------- to Issuer (Check all applicable) of Original 1419 Lake Cook Road, Suite 410 3. IRS or Social Se- Director 10% Owner (Month/Day/Year) - ------------------------------------------------- curity Number of ---- ---- (Street) Reporting Person X Officer (give Other (Voluntary) ----title below) ----(specify below) Vice President - Finance; CFO -------------------------------- Deerfield IL 60015 ###-##-#### - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial (Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5) (Instr. 4) (D) or Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 4,704 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses) SEC 1473 (8-92)
FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial Expiration (Instr. 4) Exercise Form of Ownership Date Price of Deriv- (Instr. 5) (Month/Day/ Deri- ative Year) vative Security: -------------------------------------------------- Security Direct Amount (D) or Date Expir- or Indirect Exer- ation Title Number (I) cisable Date of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options (1) 11/1/05 Common Stock 9,242 $.53 D (right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options (2) 1/29/06 Common Stock 864 $.53 D (right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options (3) 4/30/96 Common Stock 3,014 $1.99 D (right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Warrants (right to buy) 5/31/96 5/31/01 Common Stock 11,302 $7.96 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) 1,614.08 of these options become exercisable on the first day of each month beginning on September 1, 1996 and ending on November 1, 1996; and 293.31 of these options become exercisable on the first day of each month beginning on September 1, 1996 and ending on November 1, 1997. (2) 172.67 of these options become exercisable on the first day of each month beginning on September 1, 1996 and ending on January 1, 1997. (3) 1/4 of these options become exercisable on April 30, 1997 and the remaining balance become exercisable at the rate of 1/48 of the total option shares per month beginning on May 30, 1997 and ending on April 30, 2000. s/ James F. Polark 8/22/96 ------------------------------------- ---------------------- **Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person Date 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 SEC 1473 (8-92)
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