-----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, JeSstpWReOdQuVu30jh4RRWTaRVoiIJzEAXHBGTZ9X+uddFGJy/qv0H4puUSthIF DSGuMqfcXzAlBEjD8sjhXg== 0000950134-03-000218.txt : 20030106 0000950134-03-000218.hdr.sgml : 20030106 20030106141707 ACCESSION NUMBER: 0000950134-03-000218 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030102 FILED AS OF DATE: 20030106 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: SHOLTIS MARTYN R CENTRAL INDEX KEY: 0001211656 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 MAIL ADDRESS: STREET 1: C/O ROCHESTER MEDICAL INC STREET 2: ONE RCHESTER MEDICAL DRIVE CITY: STEWARTVILLE STATE: MN ZIP: 55976 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18933 FILM NUMBER: 03504664 BUSINESS ADDRESS: STREET 1: ONE ROCHESTER MEDICAL DR CITY: STEWARTVILLE STATE: MN ZIP: 55976 BUSINESS PHONE: 5075339600 MAIL ADDRESS: STREET 1: ONE ROCHESTER MEDICAL DR CITY: STEWARTVILLE STATE: MN ZIP: 55976 4 1 c73875mse4.htm FORM 4 Rochester Medical Corporation
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

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

o Check this box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b)

1. Name and Address of Reporting
Person*
(Last, First, Middle)
2. Issuer Name and Ticker or
Trading Symbol
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Sholtis, Martyn R.
  Rochester Medical Corporation (ROCM)
 
 
One Rochester Medical Drive

4. Statement for (Month/Day/Year) 5. If Amendment, Date of Original (Month/Day/Year)
    January 2, 2003
 
  (Street) 6. Relationship of Reporting Person(s) to Issuer (Check All Applicable) 7. Individual or Joint/Group Filing
(Check Applicable Line)
  Stewartville, MN 55976
(City)                (State)           (Zip)
  o  Director o  10% Owner   x Form filed by One Reporting Person
    x  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)  
        Corporate Vice President
     

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).
 

 


 


Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security
(Instr. 3)
2. Transaction Date
(Month/Day/Year)
2a. Deemed Execution
Date, if any.

(Month/Day/Year)
3. Transaction Code
(Instr. 8)
4. Securities Acquired (A)
or Disposed of (D)

(Instr. 3, 4 and 5)
5. Amount of Securities
Beneficially Owned
Following Reported
Transactions(s)

(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)

(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

              Code V   Amount (A)
or
(D)
Price            

  Common Stock             5,000     D  

  Common Stock               2,050     I   By Mother

  Common Stock               3,490     I   By Spouse

                     

                     

                     

                     

                   

                   

                   

Page 2


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative
Security

(Instr. 3)
2. Conversion or Exercise
Price of Derivative
Security
3. Transaction
Date

(Month/Day/Year)
3a. Deemed Execution
Date, if any

(Month/Day/Year)
4. Transaction
Code

(Instr. 8)
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)

(Instr. 3, 4 and 5)

                      Code V   (A) (D)

  Stock Option (Right to Buy) (1)   $6.75          

  Stock Option (Right to Buy) (1)   $14.75          

  Stock Option (Right to Buy) (1)   $15.375          

  Stock Option (Right to Buy) (1)   $15.375          

  Stock Option (Right to Buy) (1)   $10.00          

  Stock Option (Right to Buy) (1)   $5.125          

  Stock Option (Right to Buy) (1)   $4.688          

  Stock Option (Right to Buy) (1)   $4.33          

  Stock Option (Right to Buy) (1)   $8.250     1/2/03     A   5,000

             

Page 3


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date

(Month/Day/Year)
7. Title and Amount
of Underlying Securities

(Instr. 3 and 4)
8. Price of Derivative
Security

(Instr. 5)
9. Number of Derivative
Securities Beneficially Owned
Following Reported Transaction(s)

(Instr. 4)
10. Ownership Form of
Derivative Security:
Direct (D) or Indirect (I)

(Instr. 4)
11. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

  Date
Exercisable
Expiration
Date
  Title Amount or
Number of
Shares
                       

  (2) 7/1/03   Common Stock 50,000         50,000     D  

  (3) 1/1/06   Common Stock 15,000         15,000     D  

  (4) 12/31/07   Common Stock 7,707         7,707     D  

  (5) 3/5/08   Common Stock 293         293     D  

  (6) 6/17/09   Common Stock 3,000         3,000     D  

  (7) 11/21/10   Common Stock 10,000         10,000     D  

  (8) 4/6/10   Common Stock 10,000         10,000     D  

  (9) 10/16/10   Common Stock 10,000         10,000     D  

  (10) 1/2/13   Common Stock 5,000         5,000     D  

                 

Explanation of Responses:

(1) Granted under the Company's 1991 Stock Option Plan, as amended. (2) Granted on 6/13/94, 100% vested. (3) Granted on 3/28/96, 100% vested. (4) Granted on 2/4/98, 100% vested. (5) Granted on 2/4/98, 100% vested. (6) Granted on 6/17/99, options become exercisable in four equal annual installments beginning 6/17/00. (7) Granted on 11/21/00, options become exercisable in four equal annual installments beginning 11/21/01. (8) Granted on 4/6/01, options become exercisable in four equal annual installments beginning 4/6/02. (9) Granted on 10/16/01, options exercisable in four equal installments beginning 10/16/02. (1) Granted on 1/2/03, options exercisable in four equal installments beginning 1/2/04.

/s/ David Jonas, as Power of
Attorney for Martyn R. Sholtis
  01-03-03

**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 is insufficient, see Instruction 6 for procedure.
 

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