-----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, IaKrEL1D1p5oDZsJle81eP108Ynob/Zx52rcxVqEUgUIveW3OVztckXECHXm0rY8 +6pA/ZnkNLn7c0WZMRJtsw== 0000885988-99-000006.txt : 19990217 0000885988-99-000006.hdr.sgml : 19990217 ACCESSION NUMBER: 0000885988-99-000006 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981231 FILED AS OF DATE: 19990216 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTEGRAMED AMERICA INC CENTRAL INDEX KEY: 0000885988 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-OFFICES & CLINICS OF DOCTORS OF MEDICINE [8011] IRS NUMBER: 061150326 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-20260 FILM NUMBER: 99540218 BUSINESS ADDRESS: STREET 1: ONE MANHATTANVILLE RD CITY: PURCHASE STATE: NY ZIP: 10577-2100 BUSINESS PHONE: 9142538000 MAIL ADDRESS: STREET 1: 1 MANHATTANVILLE RD CITY: PURCHASE STATE: NY ZIP: 10577-2100 FORMER COMPANY: FORMER CONFORMED NAME: IVF AMERICA INC DATE OF NAME CHANGE: 19950720 COMPANY DATA: COMPANY CONFORMED NAME: CURCIO EUGENE CENTRAL INDEX KEY: 0001059787 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: ONE MANHATTANVILLE RD STREET 2: INTEGRAMED AMERICA INC CITY: PURCHASE STATE: NY ZIP: 10577-2100 BUSINESS PHONE: 9142538000 MAIL ADDRESS: STREET 1: 1 MANHATTANVILLE RD STREET 2: INTEGRAMED AMERICA INC CITY: PURCHASE STATE: NY ZIP: 10577-2100 5 1
- ---------------- U.S. SECURITIES AND EXCHANGE COMMISSION ---------------------------- |F O R M 5| Washington, D.C. 20549 | OMB APPROVAL | - ---------------- |--------------------------| Check this box if ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |OMB Number 3235-0362| [ ] no longer Subject |Expires: September 30,1998| to Section 16. |Estimated ave. burden | |hours per response.....1.0| [ ] Form 3 Holdings Rep. 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 [ ] Form 4 Trans. Rep. Section 30(f) of the Investment Company Act 1940 - ------------------------------------------------------------------------------------------------------------------------------------ |1.Name and Address of Reporting Person* |2.Issuer Name and Ticker or Trading Symbol |6.Relationship of Reporting Person to | | | | Issuer (Check all Applicable) | |Curcio Eugene R. |IntegraMed America, Inc. | | | | (INMD) | | | | | Director 10% Owner | |----------------------------------------|------------------------------------------------|--- --- | | (Last) (First) (MI)|3.IRS or Soc. Sec. No. |4.Statement for Month/ | X Officer Other | | | of Reporting Person | Year |---(give title below) ---(Specify below)| | IntegraMed America, Inc. | (Voluntary) | | | | One Manhattanville Road | | 12/31/1998 | Senior Vice President and | | | | | Chief Financial Officer | |----------------------------------------| |------------------------|----------------------------------------| | (Street) | |5.If Amendment, Date of |7. Individual or Joint/Group Filing | | | | Original (Month/Year) | (Check Applicable Line) | | | | | | |Purchase NY 10577-2100| | | X Form filed by One Reporting Person | | | | |--- | | | | | Form filed by More than One | | | | |--- Reporting Person | |----------------------------------------------------------------------------------------------------------------------------------| | (City) (State) (Zip) | | TABLE I - Non-Derivative Securities Acquired, Disposed of or Beneficially Owned | |----------------------------------------------------------------------------------------------------------------------------------| |1.Title of Security |2.Transac- |3.Trans. |4.Security Acquired (A) or |5.Amount of |6. |7.Nature of Indirect| | (Instr. 3) | tion Date | Code | Disposed of (D) | Securities |Own.| Beneficial | | |(Mon/Day/Yr)|(Instr.8)| (Instr. 3, 4 & 5) | Beneficially |Form| Ownership | | | | | | Owned at End of|(D) | (Instr. 4) | | | | |-------------------------------| Issuer's |or | | | | | | |(A) | | Fiscal Year |(I) | | | | | | Amount |(D) | Price | (Instr. 3 & 4) | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | |Common Stock | | | | | $.0000| 2500 | D | | | | | | | | | (01)| | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class securities owned directly or indirectly. SEC 2270 (7-96) *If the form is filed by more than one reporting person, see Instruction 4(b)(v). PAGE: 1 OF 2
FORM 5 (continued) TABLE II - Derivative Securities Acquired, Disposed of, Beneficially Owned (e.g., puts, calls, warrants, options, convertible security) - ------------------------------------------------------------------------------------------------------------------------------------ |1.Title of|2.Conver-|3. |4.Tran- |5.Number of |6.Date |7.Title and Amount |8.Price of|9.Number |10. |11.Nature | |Derivative|sion or |Trans| saction| Derivative |Exercisable| of Underlying |Derivative| of |Own.| of | |Security |Exercise |Date | Code | Securities |and | Securities |Security |Derivative|Form|Indirect | |(Instr. 3)|Price of |(Mon/|(Instr.8)| Acquired (A) or |Expiration | (Instr. 3 & 4) |(Instr. 5)|Securities|of |Beneficial| | |Deriva- | Day/| | Disposed of (D) |Date | | |Benefi- |Deri|Ownership | | |tive |Year)| | (Instr. 3, 4 & 5) |(Month/Day/| | |cially |Sec.|(Instr. 4)| | |Security | | | | Year) | | |Owned at |Dir.| | | | | | | |-----------|---------------------| |End of |(D) | | | | | | | | | | |Amount or | |Year |or | | | | | | |---------------------|Date |Exp. | Title |Number of | |(Instr. 4)|Ind.| | | | | | | (A) | (D) |Exbl.|Date | |Shares | | |(I) | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | |Stock Opti| $8.0000|08/31| D | | 15000|04/13|04/13|Common Sto| 15000| $8.0000 | 0| D | | |on | | 1998| | | | 1999| 2008|ck | | | | | | | | | | | | | | | | | | | | | | | | (02)| | | (02)| (03)| | | (02)| | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| |Stock Opti| $4.1200|04/13| A | 15000| |04/13|04/13|Common Sto| 15000| $4.1200 | 15000| D | | |on | | 1998| | | | 1999| 2008|ck | | | | | | | | | | | | | | | | | | | | | | | | (04)| | (04)| | (03)| | | (04)| | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (01) On November 17, 1998 the Company effected a 1-for-4 reverse stock split. (02) Cancellation of option in connection with grant of replacement option. Disposition reflects the Company's November 17, 1998 1-for-4 reverse split. (03) Exercisable as follows: 25% one year from date of grant, thereafter exercisable quarterly at a rate of 6.25%. (04) The reported transaction involved the repricing of an existing option. At the time of repricing, neither the vesting nor the expiration provisions were amended. **Intentional misstatements or omissions of facts constitute Federal /s/Eugene R. Curcio 02/16/1999 Criminal Violations. 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. SEC 2270 (7-96) 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 OMD Number Curcio, Eugene R. IntegraMed America, Inc. 12/31/1998 PAGE: 2 OF 2
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