-----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, FbX7pGeTBWXCgIlwDN8g8DCfldxhq4YP4E5Z2DPVzHNpzS3PTLpgPGxDHbegXp67 rrFaTWG70C8GkZjyVfFa7g== 0001209191-06-059392.txt : 20061114 0001209191-06-059392.hdr.sgml : 20061114 20061114182001 ACCESSION NUMBER: 0001209191-06-059392 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20061110 FILED AS OF DATE: 20061114 DATE AS OF CHANGE: 20061114 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DATATRAK INTERNATIONAL INC CENTRAL INDEX KEY: 0000886530 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 341685364 STATE OF INCORPORATION: OH FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 6150 PARKLAND BLVD STREET 2: SUITE 100 CITY: MAYFIELD HEIGHTS STATE: OH ZIP: 44124 BUSINESS PHONE: 4404430082 MAIL ADDRESS: STREET 1: 20600 CHAGRIN BLVD STREET 2: STE 1050 CITY: CLEVELAND STATE: OH ZIP: 44122 FORMER COMPANY: FORMER CONFORMED NAME: COLLABORATIVE CLINICAL RESEARCH INC DATE OF NAME CHANGE: 19960311 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GREEN JEFFREY A CENTRAL INDEX KEY: 0001105840 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-20699 FILM NUMBER: 061217389 BUSINESS ADDRESS: BUSINESS PHONE: 2169216505 MAIL ADDRESS: STREET 1: 20600 CHAGRIN BLVD CITY: CLEVELAND STATE: OH ZIP: 44122 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2006-11-10 0 0000886530 DATATRAK INTERNATIONAL INC DATA 0001105840 GREEN JEFFREY A 6150 PARKLAND BLVD. SUITE 100 MAYFIELD HTS. OH 44124 1 1 0 0 President and CEO Common Shares, without par value 2006-11-10 4 P 0 2000 4.46 A 286832 D Common Shares, without par value 2006-11-10 4 P 0 2000 4.48 A 288832 D Common Shares, without par value 110953 I By Wife Common Shares, without par value 1450 I By Son Common Shares, without par value 1500 I By Daughter Common Shares, without par value 1500 I By Daughter Employee Stock Option (right to buy) 7.17 1999-04-20 2007-01-02 Common Shares 37500 37500 D Employee Stock Option (right to buy) 2.42 2003-12-09 2009-12-09 Common Shares 135000 172500 D Employee Stock Option (right to buy) 1.85 2006-06-04 2012-06-04 Common Shares 33750 206250 D Employee Stock Option (right to buy) 4.05 2005-12-23 2013-12-23 Common Shares 1500 207750 D Employee Stock Option (right to buy) 4.05 2007-12-23 2013-12-23 Common Shares 15000 222750 D Employee Stock Option (right to buy) 7.35 2008-12-28 2014-12-28 Common Shares 18000 240750 D The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is a beneficial owner of such securities for purposes of Section 16 or for any other purpose. Options were granted under the Company's Amended and Restated 1996 Key Employees and Consultants Stock Option Plan in reliance upon the exemption provided by Rule 16b-3. /s/ Jeffrey A. Green, by Arthur C. Hall III, his attorney-in-fact, pursuant to Power of Attorney dated October 28, 2005, on file with the Commission. 2006-11-14 -----END PRIVACY-ENHANCED MESSAGE-----