-----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, SolNjajn1wyHOdgTMW1AkPx3fV7EbeEIVz5LSkIW+0oVj1hLNyDI27Y7Z9tZKu/3 cGbXal5TOg9FRbuDWef3Cg== 0001181431-05-059341.txt : 20051103 0001181431-05-059341.hdr.sgml : 20051103 20051103100819 ACCESSION NUMBER: 0001181431-05-059341 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051101 FILED AS OF DATE: 20051103 DATE AS OF CHANGE: 20051103 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMERICAN DENTAL PARTNERS INC CENTRAL INDEX KEY: 0001028087 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 043297858 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 201 EDGEWATER DRIVE STREET 2: SUITE 285 CITY: WAKEFIELD STATE: MA ZIP: 01880-1249 BUSINESS PHONE: 781-224-0880 MAIL ADDRESS: STREET 1: 201 EDGEWATER DRIVE STREET 2: SUITE 285 CITY: WAKEFIELD STATE: MA ZIP: 01880 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SERRAO GREGORY A CENTRAL INDEX KEY: 0001234983 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23363 FILM NUMBER: 051175349 BUSINESS ADDRESS: STREET 1: 201 EDGEWATER DRIVE CITY: WAKEFIELD STATE: MA ZIP: 01880 4 1 rrd96004.xml X0202 4 2005-11-01 0 0001028087 AMERICAN DENTAL PARTNERS INC ADPI 0001234983 SERRAO GREGORY A 201 EDGEWATER DRIVE WAKEFIELD MA 01880 1 1 0 0 Chief Executive Officer Common Stock 2005-11-01 4 M 0 14400 8.33 A 450828 D Common Stock 2005-11-01 4 M 0 37500 4.83 A 450828 D Common Stock 2005-11-01 4 M 0 16100 4.63 A 450828 D Common Stock 2005-11-01 4 S 0 51900 20.667 D 450828 D Common Stock 2005-11-01 4 S 0 16100 20.6837 D 450828 D Common Stock 2005-11-02 4 M 0 10000 4.63 A 450828 D Common Stock 2005-11-02 4 M 0 30000 4.75 A 450828 D Common Stock 2005-11-02 4 S 0 1500 21.175 D 450828 D Common Stock 2005-11-02 4 S 0 8500 20.8372 D 450828 D Common Stock 2005-11-02 4 S 0 20000 21.1726 D 450828 D Common Stock 2005-11-02 4 S 0 10000 21.25 D 450828 D Nonqualified option granted 01/01/1997 (right to buy) 8.33 2005-11-01 4 M 0 14400 0 D 1998-01-01 2007-01-01 Common Stock 14400 480884 D Nonqualified option granted 02/26/1999 (right to buy) 4.83 2005-11-01 4 M 0 37500 0 D 2000-02-26 2009-02-26 Common Stock 37500 480884 D Nonqualified option granted 03/08/2000 (right to buy) 4.63 2005-11-01 4 M 0 16100 0 D 2001-03-08 2010-03-08 Common Stock 16100 480884 D Nonqualified option granted 03/08/2000 (right to buy) 4.63 2005-11-02 4 M 0 10000 0 D 2001-03-08 2010-03-08 Common Stock 10000 480884 D Nonqualified option granted 11/08/2000 (right to buy) 4.75 2005-11-02 4 M 0 30000 0 D 2001-11-08 2010-11-08 Common Stock 30000 480884 D Number of shares reflects the 3-for-2 stock split effected by the issuer in October 2005. Does not include 50,922 shares of common stock held indirectly by reporting person through joint ownership with spouse, through other members of immediately family, and through a trust for the benefit of members of immediate family. Conversion or exercise price reflects the 3-for-2 stock split effected by the issuer in October 2005. Total number of derivative securities beneficially owned (480,884) reflects all options held by reporting person pursuant to employee benefit plans of issuer. Option vested with respect to 25% of shares subject to option on each of the first four anniversaries of the date of grant. Mark W. Vargo, Attorney-in-Fact and Agent 2005-11-03 -----END PRIVACY-ENHANCED MESSAGE-----