-----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, B8/I8GFKHQISjKbpcskgP/6OBcCT7Gx2SMfWQBfZue/T3Apw1Ezu9HbAWMukLswM cbY4TAHIpd90FNumwzCODg== 0000897101-97-000257.txt : 19970311 0000897101-97-000257.hdr.sgml : 19970311 ACCESSION NUMBER: 0000897101-97-000257 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19970116 FILED AS OF DATE: 19970310 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ROCHESTER MEDICAL CORPORATION CENTRAL INDEX KEY: 0000868368 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 411613227 STATE OF INCORPORATION: MN FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18933 FILM NUMBER: 97553259 BUSINESS ADDRESS: STREET 1: 1500 SECOND AVE N W CITY: STEWARTVILLE STATE: MN ZIP: 55976 BUSINESS PHONE: 5075334203 MAIL ADDRESS: STREET 1: 1500 SECOND AVE NW CITY: STEWARTVILLE STATE: MN ZIP: 55976 COMPANY DATA: COMPANY CONFORMED NAME: CONWAY PETER R CENTRAL INDEX KEY: 0001033107 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 1500 SECOND AVE NW CITY: STEWARTVILLE STATE: MN ZIP: 55976 MAIL ADDRESS: STREET 1: 1500 SECOND AVE NW CITY: STEWARTVILLE STATE: NC ZIP: 55976 5 1 ROCHESTER MEDICAL CORPORATION FORM 5 MARCH 97 FORM 5 OMB APPROVAL [ ] CHECK BOX IF NO LONGER SUBJECT OMB Number 3235-0362 TO SECTION 16. FORM 4 OR FORM 5 Expires: February 1, 1994 OBLIGATIONS MAY CONTINUE. SEE Estimated average burden INSTRUCTION 1(b). hours per response .. 1.0 [ ] FORM 3 HOLDINGS REPORTED [XX] FORM 4 TRANSACTIONS REPORTED U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 ANNUAL 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(f) of the Investment Company Act of 1940 - ------------------------------------------------------------------------------- 1. Name and Address of Reporting Person Conway Peter R. - ----------------------------------------------------- (Last) (First) (Middle) 501 Old Territorial Road - ----------------------------------------------------- (Street) Chatfield MN 55923 - ----------------------------------------------------- (City) (State) (Zip) - ------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Rochester Medical Corporation (ROCM) - ------------------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) - ------------------------------------------------------------------------------- 4. Statement for Month/Year JAN 96 - ------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) - ------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] 10% Owner [X] Director [ ] Officer (give title below) [ ] Other (specify below) -------------------------------------------------- -------------------------------------------------- - ------------------------------------------------------------------------------- Page 1 FORM 5 (continued)
TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. - --------------------- -------- ---------- ------------------------------ ----------- ---------- ---------- Owner- Amount of ship Trans- Securities Acquired (A) Securities Form: action or Disposed of (D) Beneficially Direct Nature of Date Trans- (Instr. 3, 4 and 5) Owned at End (D) or Indirect Title of (Month/ action ---------------------------- of Month Indirect Beneficial Security Day/ Code Amount (A) or Price (Instr. (I) Ownership (Instr. 3) Year) (Instr. 8) (D) 3 and 4) (Instr. 4) (Instr. 4) - --------------------- -------- ---------- ----------- ------ --------- ----------- ---------- ---------- Common Stock 75,200 D
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) Page 2 FORM 5 (CONTINUED)
TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G. PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. - ---------- -------- -------- -------- ---------- ------------ -------------- ------ ---------- --------- ---------- Title and Ownership Number of Date Exer- Amount of of Derivative cisable and Underlying Number of Deriv- Securities Expiration Securities Price Derivative ative Conver- Acquired (A) Date (Month/ (Instr. 3 of Securities Security: sion or Trans- or Disposed Day/Year) and 4) Deriv- Benefi- Direct Exercise action Trans- of (D) -------------- -------------- ative cially (D) or Nature of Title of Price of Date action (Instr. 3, Date Amount Secur- Owned at Indirect Indirect Derivative Deriv- (Month/ Code 4 and 5) Exer- Expir- or Num- ity End of (I) Beneficial Security ative Day/ (Instr. ---------- cis- ation ber of (Instr. Month (Instr. Ownership (Instr. 3) Security Year) 8) (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4) - ---------- -------- -------- -------- ---- ---- ------- ----- ----- ------ ------ ---------- -------- ---------- Common Option $20.00 1/16/97 A 1,000 1/16/97 9/30/06 Stock 1,000 (1) 25,000 D
(1) Annual automatic grant to non-employee director. Explanation of Responses: - ----------------------------------------------------- - ----------------------------------------------------- /s/ Peter R. Conway 3/5/97 ---------------------------------------- -------------------- ** Signature of Reporting Person 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 3 -----END PRIVACY-ENHANCED MESSAGE-----