-----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, OPTs4YZQ417KbnaQiaoyIvcrxk18gFDrbP8jFc5EH4gginfwiYKtWnpeCAA/+ZkV KAOz0VAfM1ezHfc2fvux3g== 0000912057-02-040384.txt : 20021031 0000912057-02-040384.hdr.sgml : 20021031 20021030195145 ACCESSION NUMBER: 0000912057-02-040384 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020114 FILED AS OF DATE: 20021031 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: ADAMS TIMOTHY J CENTRAL INDEX KEY: 0001194554 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: LABOR READY INC STREET 2: 1015 A ST PO BOX 2910 CITY: TACOMA STATE: WA ZIP: 98401 BUSINESS PHONE: 2533839101 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: LABOR READY INC CENTRAL INDEX KEY: 0000768899 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HELP SUPPLY SERVICES [7363] IRS NUMBER: 911287341 STATE OF INCORPORATION: WA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14543 FILM NUMBER: 02803874 BUSINESS ADDRESS: STREET 1: 1016 S. 28TH STREET CITY: TACOMA STATE: WA ZIP: 98409 BUSINESS PHONE: (253)-383- MAIL ADDRESS: STREET 1: 1016 S. 28TH STREET CITY: SEATTLE STATE: WA ZIP: 98409- FORMER COMPANY: FORMER CONFORMED NAME: DICKS HAMBURGERS INC DATE OF NAME CHANGE: 19900329 4 1 a2092385z4.htm 4

    FORM 4

o Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

(Print or Type Responses)
  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(h) of the Investment Company Act of 1940
 
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1.   Name and Address of Reporting Person*   2.   Issuer Name and Ticker or Trading Symbol   6.   Relationship of Reporting Person(s) to Issuer
(Check all applicable)
    Adams   Timothy   J.       Labor Ready, Inc. (LRW)                Director            10% Owner

 
           
    (Last)   (First)   (Middle)   3.   I.R.S. Identification Number of Reporting Person, if an entity (voluntary)   4.   Statement for
Month/Day/Year
        X   Officer
        (give title below)
           Other
        (specify below)
    1015 A Street               01/14/02       General Counsel

 
 
     
(Street)           5.   If Amendment, Date of Original (Month/Day/Year)   7.   Individual or Joint/Group Filing
(Check Applicable Line)
    X     Form filed by One Reporting Person
             Form filed by More than
    Tacoma   WA   98401                                   One Reporting Person

    (City)   (State)   (Zip)                            
                Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1.   Title of Security
(Instr. 3)
  2.   Transaction Date   2A.   Deemed Execution Date, if any   3.   Transaction Code
(Instr. 8)
  4.   Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
  5.   Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
  6.   Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
  7.   Nature of Indirect Beneficial Ownership
(Instr. 4)
            (Month/Day/Year)   (Month/Day/Year)  
                       
                            Code   V       Amount   (A) or (D)   Price                        

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         


FORM 4 (Continued)   Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
(
e.g., puts, calls, warrants, options, convertible securities)

1.   Title of Derivative Security
(Instr. 3)
  2.   Conversion or Exercise Price of Derivative Security   3.   Transaction Date
(Month/Day/Year)
  3A.   Deemed Execution Date, if any
(Month/Day/Year)
  4.   Transaction Code
(Instr. 8)
  5.   Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
  6.   Date Exercisable and Expiration Date (Month/Day/Year)
                               
 
                                    Code   V       (A)   (D)       Date
Exercisable
  Expiration Date

Options (Right to Buy)   $5.62       1/14/2002               A   V       20,000           *   1/14/2007

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 


7.   Title and Amount of Underlying Securities
(Instr. 3 and 4)
  8.   Price of Derivative Security
(Instr. 5)
  9.   Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
  10.   Ownership Form of Derivative Securities: Direct (D) or Indirect (I) (Instr. 4)   11.   Nature of Indirect Beneficial Ownership
(Instr. 4)
   
                               
    Title   Amount or Number of Shares                                

    Common stock   20,000               20,000       D        

                                         

                                         

                                         

                                         

                                         

                                         

                                         

                                         

                                         

                                         

Explanation of Responses:
*  25% shall vest on each of 01/14/03, 01/14/04, 01/14/05 and 01/14/06.

/s/ Gary Kocher   10/30/02

**Signature of Reporting Person
Gary Kocher, Attorney in fact
 
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.

http://www.sec.gov/divisions/corpfin/forms/form4.htm
Last update: 09/05/2002



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