5 1 e-9577.txt FORM 5 OF DONNA L. LUCCHESI ------------------------------ OMB APPROVAL ------------------------------ ------ OMB Number: 3235-0362 FORM 5 Expires: January 31, 2005 ------ Estimated average burden hours per response ....... 1.0 ------------------------------ UNITED STATES 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(h) of the Investment Company Act of 1940 [ ] Check this box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [ ] Form 3 Holdings Report [X] Form 4 Transactions Reported ================================================================================ 1. Name and Address of Reporting Person* Lucchesi Donna L. -------------------------------------------------------------------------------- (Last) (First) (Middle) 1275 West Washington Street -------------------------------------------------------------------------------- (Street) Tempe Arizona 85281 -------------------------------------------------------------------------------- (City) (State) (Zip) ================================================================================ 2. Issuer Name AND Ticker or Trading Symbol OrthoLogic Corp. (OLGC) ================================================================================ 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) ================================================================================ 4. Statement for Month/Year November 30, 2002 ================================================================================ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) V.P. - Marketing ------------------------------------ ================================================================================ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by One Reporting Person [ ] Form filed by More Than one Reporting Person ================================================================================ Page 1 of 3 Form 5 (continued) Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
======================================================================================================================== | | | | | | | | | | | | 5. Amount| | | | | | | of Secur-| | | | | | 4. | ities | | 7. | | | | Securities | Bene- | | Nature | | | | Acquired (A) | ficially | 6. Owner-| of | | | | or Disposed | Owned at | ship | Indirect | | 2A. | | of (D) (Instr. | End of | Form: | Bene- | | Deemed | | 3, 4 and 5) | Issuer's | Direct | ficial | 2. Trans- | Execution | 3. | ---------------- | Fiscal | (D) or | Owner- | action Date | Date, if any| Transaction | |(A)| | Year | Indirect | ship 1. Title of Security | (Month/Day/ | (Month/Day/ | Code | Amount|or |Price | (Instr. | (I) | (Instr. (Instr. 3) | Year) | Year) | (Instr. 8) | |(D)| | 3 and 4) | (Instr.4)| 4) ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ========================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Page 2 of 3 Form 5 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
========================================================================================================================= | | | | |5. | | | | 9. |10. | | | | | |Number | | | | Number |Owner-| | | | | |of | |7. | | of |ship | |2. | | | |Deriv- | |Title and | | Deriv- |of | |Conver-| | | |ative | |Amount of | | ative |Deriv-|11. |sion | | | |Secur- | |Underlying | | Secur- |ative |Nature |of | |3A. | |ities |6. |Securities |8. | ities |Secur-|of |Exer- | |Deemed | |Acquired |Date |(Instr. 3 |Price | Bene- |ity: |In- |cise |3. |Execu- | |(A) or |Exercisable and |and 4) |of | ficially|Direct|direct |Price |Trans- |tion |4. |Disposed |Expiration Date |-------------|Deriv- | Owned |(D) or|Bene- 1. |of |action |Date, |Trans- |of(D) |(Month/Day/Year) | |Amount|ative | at End |In- |ficial Title of |Deriv- |Date |if any |action |(Instr.3,|-----------------| |or |Secur- | of |direct|Owner- Derivative |ative |(Month/ |(Month/ |Code |4 and 5) |Date | Expira-| |Number|ity | Year |(I) |ship Security |Secur- |Day/ |Day/ |(Instr.|-------- |Exer- | tion | |of |(Instr.| (Instr. |(Instr|(Instr. (Instr. 3) |ity |Year) |Year) |8) |(A) | (D)|cisable | Date |Title |Shares|5) | 4) |4) |4) ------------------------------------------------------------------------------------------------------------------------- Stock Option $3.50 11/11/02 A 20,000 (1) 11/11/12 Common 20,000 20,000 D (Right to buy) Stock ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- =========================================================================================================================
Explanation of Responses: (1) Vests as to 5,000 shares on November 11, 2003 and as to 416.667 shares monthly thereafter. By: Sherry A. Sturman 02/10/03 ------------------------------- ------------ **Signature of Reporting Person Date Attorney-in-Fact ** 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 procedures. Page 3 of 3