-----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, PMByJcIqDC+D76iFUmv8c7tdL+RkG3fppqPt7ADETEg4WRfYDvXeADeew7r5xnHf nudHLna8UaNhGi7Hlw6/bQ== 0000915127-02-000036.txt : 20020906 0000915127-02-000036.hdr.sgml : 20020906 20020906135824 ACCESSION NUMBER: 0000915127-02-000036 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020906 FILED AS OF DATE: 20020906 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PHC INC /MA/ CENTRAL INDEX KEY: 0000915127 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HOME HEALTH CARE SERVICES [8082] IRS NUMBER: 042601571 STATE OF INCORPORATION: MA FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22916 FILM NUMBER: 02758329 BUSINESS ADDRESS: STREET 1: 200 LAKE ST STE 102 CITY: PEABODY STATE: MA ZIP: 01960 BUSINESS PHONE: 9785362777 MAIL ADDRESS: STREET 1: 200 LAKE ST STREET 2: STE 102 CITY: PEABODY STATE: MA ZIP: 01960 COMPANY DATA: COMPANY CONFORMED NAME: PHC INC /MA/ CENTRAL INDEX KEY: 0000915127 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HOME HEALTH CARE SERVICES [8082] OFFICER IRS NUMBER: 042601571 STATE OF INCORPORATION: MA FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 200 LAKE ST STE 102 CITY: PEABODY STATE: MA ZIP: 01960 BUSINESS PHONE: 9785362777 MAIL ADDRESS: STREET 1: 200 LAKE ST STREET 2: STE 102 CITY: PEABODY STATE: MA ZIP: 01960 4 1 pw_0902.txt STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP U.S. SECURITIES AND EXCHANGE COMMISSION FORM 4 Washington, D.C. 20549 OMB APPROVAL ________________________________ ____ Check box OMB Number 3235-0287 if no longer Expires: January 31, 2005 subject to STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden Section 16, hours per response......0.5 Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities Exchange obligations may Act of 1934, Section 17(a) of the Public Utility continue. See Holding Company Act of 1935 or Section 30(f) of the Investment Instruction 1(b). Company Act of 1940 ___________________________________________________________________________________________________________________________________ (Print or type response) ___________________________________________________________________________________________________________________________________ 1. Name and Address of 2. Issuer Name and Ticker or 6. Relationship of Reporting Reporting Person Trading Symbol Person to Issuer (Check all applicable) PHC, Inc. - PIHC ____ Director ____ 10% Owner X Officer ____ Other (give title (Specify below) below) Controller, Treasurer and Assistant Wurts Paula C. Clerk, CFO ___________________________________________________________________________________________________________________________________ (Last) (First) (Middle) 3. IRS or Identification Number 4. Statement for of Reporting Person, if an entity Month/Year (Voluntary) September 2002 7 Alexandra Street ___________________________________________________________________________________________________________________________________ (Street) 5. If Amendment, 7. Individual or Joint/Group Filing Date of Original (check applicable line) (Month/Year) X Form filed by One Reporting Person Peabody MA 01960 ___Form filed by More than One Reporting Person ___________________________________________________________________________________________________________________________________ (City) (State) (Zip) Table 1 - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ___________________________________________________________________________________________________________________________________ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired 5. Amount of 6. Owner- 7. Nature Instr. 3) action action or (A) of Disposed (D) Securities ship of Date Code (Instr. 3, 4 and 5) Beneficially Form: Indirect (Instr. 8) Owned at End Direct Beneficial (Month/ of Month (D) or Ownership Day/ (Instr. 3 Indirect Year) and 4) (I) (Inst 4) (Inst 4) ___________________________________________________________________________________________________________________________________ Code V Amount (A) or (D) Price ___________________________________________________________________________________________________________________________________ Class A Common Stock 24,310 D ___________________________________________________________________________________________________________________________________ Class A Common Stock 09/05/02 Acuired 35,459 A .25 D ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ Total Class A Common Stock 59,769 ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ 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 Instructions 4(b)(v). PERSONS WHO RESPOND TO THE COLLECTION OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER. (Over) SEC 1473 (3-00) ___________________________________________________________________________________________________________________________________ FORM 4 (Continued) Table II - Derivative, Securities, Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ___________________________________________________________________________________________________________________________________ l. Title 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date 7. Title 8. Price 9. Number 10. Owner- 11. Nature of sion of action action Derivative Exer- and of of Deriv- ship of Deriva- Exercise Date Code Securities cisable Amount Deriv- ative Form of In- tive Price of (Instr. Acquired and of ative Securi- Deriv- direct Security Derivative (Month/ 8) (A) or Expira- Underlying Secur- ties ative Bene- (Instr. 3) Security Day/ Disposed tion Securities ity Benefi- Security fical Year) of (D Date (Instr. 3 (Instr. cally Direct Owner- Inst. 3, 4 and 4) 5) Owned at (D) or ship and 5) (Month/ End of Indirect (Instr. Day/ Month (I) 4) Year) (Instr. 4) (Instr. 4) ___________________________________________________________________________________________________________________________________ Date Expir- Title Amount Excer- ation or sible Date Number of Shares ___________________________________________________________________________________________________________________________________ Code V (A) (D) ___________________________________________________________________________________________________________________________________ Stock Options (Right to Buy) 137,084 D ___________________________________________________________________________________________________________________________________ Stock Option .25 09/05/02 Excercised 59,417 .62 ___________________________________________________________________________________________________________________________________ Total Options Held 77,667 ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ Explanation of Response: Shares acquired through cashless exercise of stock options. **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Paula C. Wurts 09/06/02 _______________________________________________ See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a) **Signature of Reporting Person Date 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 informtion contained in this form are not required to respond unless the form displays a currently valid OMB Number Page 2
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