-----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, Jbf1XBORqvto7oKv98ZSHmFcUNEYJdhyAvo064xqeIQIGbvL7s1b7DDriXXAzYjx rVbzgPyaWC27lRNLLcMtyw== 0000351721-03-000110.txt : 20030409 0000351721-03-000110.hdr.sgml : 20030409 20030408175525 ACCESSION NUMBER: 0000351721-03-000110 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030408 FILED AS OF DATE: 20030409 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: CHAVEZ CHRISTOPHER G CENTRAL INDEX KEY: 0001192858 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 MAIL ADDRESS: STREET 1: 6501 WINDCREST DR STREET 2: SUITE 100 CITY: PLANO STATE: TX ZIP: 75024 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ADVANCED NEUROMODULATION SYSTEMS INC CENTRAL INDEX KEY: 0000351721 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 751646002 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10521 FILM NUMBER: 03643221 BUSINESS ADDRESS: STREET 1: 6501 WINDCREST DRIVE SUITE 100 CITY: PLANO STATE: TX ZIP: 75024 BUSINESS PHONE: 9723098000 MAIL ADDRESS: STREET 1: 6501 WINDCREST DRIVE SUITE 100 CITY: PLANO STATE: TX ZIP: 75024 FORMER COMPANY: FORMER CONFORMED NAME: QUEST MEDICAL INC DATE OF NAME CHANGE: 19920703 4 1 chavez040803.txt FORM 4 ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response.........0.5 ------------------------------ 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 |_| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print of Type Responses) ________________________________________________________________________________ 1. Name and Address of Reporting Person* Chavez Christopher G. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 2900 Cedar Ridge Rd. - -------------------------------------------------------------------------------- (Street) McKinney Texas 75070 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Advanced Neuromodulation Systems, Inc. (ANSI) ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) 75-1646002 ________________________________________________________________________________ 4. Statement for Month/Day/Year 04/08/03 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) |_| Director |_| 10% Owner |X| Officer (give title below) |_| Other (specify below) President and Chief Executive Officer ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check Applicable line) |X| Form Filed by One Reporting Person |_| Form Filed by More than One Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
5. Amount of 6. 4. Securities Owner- Securities Acquired (A) or Beneficially ship 2A. 3. Disposed of (D) Owned Form: 7. 2. Deemed Transaction (Instr. 3, 4 and 5) Following Direct Nature of Trans- Execution Code ------------------------------- Reported (D) or Indirect 1. action Date, if (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Date any ------------ or (Instr. 3 & (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V Amount (D) Price Instr.4) (Instr.4) (Instr.4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 04/08/03 M V $5.00 A 14,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
9. Number 10. of Owner- deriv- ship ative Form 2. Secur- of Conver- 5. 7. ities Deriv- 11. sion Number of Title and Amount Bene- ative Nature or Derivative 6. of Underlying 8. ficially Secur- of Exer- 3A. 4. Securities Date Securities Price Owned ity: In- cise Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Follow- Direct direct Price 3. Execut- action or Disposed Expiration Date ---------------- Deriv- ing (D) or Bene- 1. of Trans- ion Code of(D) (Month/Day/Year) Amount ative Reported In- ficial Title of Deriv- action Date if (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner- Derivative ative Date any 8) 4 and 5) Date Expira- Number ity action(s) (I) ship Security Secur- (mm/dd/ (mm/dd/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity yy) yy) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Right to $5.00 11/05/98(1,3) A 200,000 11/05/98 11/06/08 Common 200,000 200,000 D Purchase 12/28/00 M V 15,000 Stock 15,000 185,000 D Stock 01/12/00 M V 15,000 15,000 170,000 D Option 12/27/01 M V 18,483 18,483 151,517 D 12/27/01 M V 1,517 1,517 150,000 D 08/22/02 M V 20,000 20,000 130,000 D 03/17/03 M V 10,000 10,000 120,000 D 03/27/03 M V 10,000 10,000 110,000 D 03/28/03 M V 10,000 10,000 100,000 D 04/08/03 M V 14,000 14,000 86,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Right to $6.625 03/31/99(3) A V 25,000 03/31/00 04/01/09 Common 25,000 25,000 D Purchase Stock Stock Option - ------------------------------------------------------------------------------------------------------------------------------------ Right to $15.375 03/17/00(3) A V 17,500 03/17/01 03/18/10 Common 17,500 17,500 D Purchase Stock Stock Option - ------------------------------------------------------------------------------------------------------------------------------------ Right to $12.250 06/01/00(2) A V 500 06/01/01 06/02/10 Common 500 500 D Purchase Stock Stock Option - ------------------------------------------------------------------------------------------------------------------------------------ Right to $14.250 07/31/00(4) A V 25,000 07/31/01 08/01/10 Common 25,000 25,000 D Purchase Stock Stock Option - ------------------------------------------------------------------------------------------------------------------------------------ Right to $10.625 04/03/01(3) A V 25,000 04/03/02 04/04/11 Common 25,000 25,000 D Purchase Stock Stock Option - ------------------------------------------------------------------------------------------------------------------------------------ Right to $28.530 02/20/02(3) A V 50,000 02/20/03 02/21/12 Common 50,000 50,000 D Purchase Stock Stock Option - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) Options granted pursuant to 1979 Stock Option Plan, 25% vesting per year. (2) Options granted pursuant to 1995 Stock Option Plan, 25% vesting per year. (3) Options granted pursuant to 1998 Stock Option Plan, 25% vesting per year. (4) Options granted pursuant to 2000 Stock Option Plan, 25% vesting per year. Christopher G. Chavez By:/s/Linda D. Moses, Agent and Attorney-in-Fact for Christopher G. Chavez April 8, 2003 - ----------------------------------------------------- ----------------------- **Signature of Reporting Person Date 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). ** 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. Page 2 -----END PRIVACY-ENHANCED MESSAGE-----