-----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, MEyKIVTh+bATRgprirAUirWdNLcsPsCygc1BO4VofvPKJXqMIJ4ujTnqoQxWLtIV WFpB++nWJCnmRcqgJwpW6Q== 0000950147-01-500028.txt : 20010122 0000950147-01-500028.hdr.sgml : 20010122 ACCESSION NUMBER: 0000950147-01-500028 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001123 FILED AS OF DATE: 20010104 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FRONTIER ADJUSTERS OF AMERICA INC CENTRAL INDEX KEY: 0000735349 STANDARD INDUSTRIAL CLASSIFICATION: PATENT OWNERS & LESSORS [6794] IRS NUMBER: 860477573 STATE OF INCORPORATION: AZ FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-12902 FILM NUMBER: 1501883 BUSINESS ADDRESS: STREET 1: 45 E MONTEREY WAY STREET 2: STE 202 CITY: PHOENIX STATE: AZ ZIP: 85011 BUSINESS PHONE: 6022641061 MAIL ADDRESS: STREET 1: P O BOX 7610 CITY: PHOENIX STATE: AZ ZIP: 85011 FORMER COMPANY: FORMER CONFORMED NAME: FRONTIER FINANCIAL CORP /AZ DATE OF NAME CHANGE: 19861114 COMPANY DATA: COMPANY CONFORMED NAME: PASCUCCI MICHAEL C CENTRAL INDEX KEY: 0000937382 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 7100 EAST LINCOLN DRIVE STREET 2: SUITE D-230 CITY: SCOTTSDALE STATE: AZ ZIP: 85253 MAIL ADDRESS: STREET 1: 7100 EAST LINCOLN DRIVE STREET 2: SUITE D-230 CITY: SCOTTSDALE STATE: AZ ZIP: 85253 4 1 e-5984.txt FORM 4 FOR MICHAEL C. PASCUCCI - ------ ------------------------------------- FORM 4 OMB APPROVAL - ------ ------------------------------------- [ ] Check this box if no longer OMB Number 3235-0287 subject to Section 16. Form 4 Expires: December 31, 2001 or Form 5 obligations may Estimated average burden continue. See Instruction 1(b). hours per response............. 0.5 ------------------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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(f) of the Investment Company Act of 1940 ================================================================================ 1. Name and Address of Reporting Person* Pascucci Michael C - -------------------------------------------------------------------------------- (Last) (First) (Middle) 270 South Service Road, Suite 45 - -------------------------------------------------------------------------------- (Street) Melville New York 11747-2339 - -------------------------------------------------------------------------------- (City (State) (Zip) ================================================================================ 2. Issuer Name and Ticker or Trading Symbol Frontier Adjusters of America, Inc. (FAJ) ================================================================================ 3. IRS Or Social Security Number of Reporting Person (Voluntary) ================================================================================ 4. Statement for Month/Year December 2000 ================================================================================ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ ] Director [X] 10% Owner (1) [ ] Officer (give title below) [ ] Other (specify below) ----------------------------- ================================================================================ 7. Individual or Joint/Group Filing (Check Applicable Line) [X] Form filed by One Reporting Person [ ] Form filed by More than One Reporting Person ================================================================================ Form 4 (continued)
================================================================================================================== TABLE I--NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ================================================================================================================== 1.Title of Security 2.Trans- 3.Trans- 4.Securities Acquired (A) 5.Amount of 6.Owner- 7.Nature of (Instr. 3) action action or Disposed of (D) Securities ship Indirect Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial (Month/ (Instr. 8) Owned at Direct Owner- Day/ ---------- ---------------------- End of Month (D) or ship Year) (A) or (Instr. 3 and 4) Indirect I) (Instr. 4) Code V Amount (D) Price (Instr. 4) - ------------------------------------------------------------------------------------------------------------------ Common Stock 11/27/00 P 1,300 A 1,872.00 D - ------------------------------------------------------------------------------------------------------------------ Common Stock 11/28/00 P 10,500 A 20,036.10 11,800(2) D - ------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------ ================================================================================================================== Table II--DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities) =============================================================================================== 1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Derivative Security (Instr. 3) sion or action tion Securities Acquired Exercise Date Code (A) or Disposed Price of (Month/ (Instr. 8) of (D)(Instr. 3,4, and 5) Derivative Day/ ----------- ------------------------- Security Year) Code V (A) (D) - ----------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------- =============================================================================================== 6.Date Exer- 7.Title and Amount of 8.Price 9.Number 10.Owner- 11. Nature cisable and Underlying Securities of of Deriv- ship of Expiration (Instr. 3 and 4) Deriv- ative Form of Indirect Date (Month/ ative Securities Deriv- Benefi- Day/Year) Security Bene- ative cial ---------------- -------------------- (Instr.5) ficially Security: Owner- Date Expira- Title Amount or Owned at Direct (D) ship Exer- tion Number of End of Month or Indirect (Instr.4) cisable Date Shares (Instr. 4) (I)(Instr.4) - ----------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------- ===============================================================================================
Explanation of Responses: /s/ Michael C. Pascucci December 29, 2000 ------------------------------- ----------------- **Signature of Reporting Person Date (1) The Reporting Person may be deemed to share voting and dispositive power over the shares of Common Stock of the Issuer described in Item 2. The Reporting Person disclaims beneficial ownership of these securities and the filing of this Form 4 shall not be deemed an admission that the Reporting Person is a beneficial owner or has voting or dispositive power over such securities for any purposes under the Act. (2) Does not include 5,258,513 shares owned by United Financial Adjusting Company with regard to which the Reporting Person disclaims any beneficial interest. ** 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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. -----END PRIVACY-ENHANCED MESSAGE-----