-----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, Jg6miMOjNyOAs8GgQKFjpv5eafbnmNzJ5z/72JbXHxWDczUb1e1nbiyh2l2Cy2GT nm1FVvh7JHgu2UYXN8JaLQ== 0001025894-01-000001.txt : 20010122 0001025894-01-000001.hdr.sgml : 20010122 ACCESSION NUMBER: 0001025894-01-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001231 FILED AS OF DATE: 20010104 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PEDIATRIC SERVICES OF AMERICA INC CENTRAL INDEX KEY: 0000893430 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HOME HEALTH CARE SERVICES [8082] IRS NUMBER: 581873345 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-23946 FILM NUMBER: 1501937 BUSINESS ADDRESS: STREET 1: 31O TECHNOLOGY PKWY CITY: NORCROSS STATE: GA ZIP: 30092-2929 BUSINESS PHONE: 7704411580 MAIL ADDRESS: STREET 1: 310 TECHNOLOGY PKWY CITY: NORCROSS STATE: GA ZIP: 30092-2929 COMPANY DATA: COMPANY CONFORMED NAME: NIERENBERG DAVID CENTRAL INDEX KEY: 0001040899 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 19605 N E 8TH STREET CITY: CAMAS STATE: WA ZIP: 98607 BUSINESS PHONE: 3606048600 4 1 0001.txt FORM 4 - DAVID NIERENBERG FORM 4 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* David Nierenberg The D3 Family Fund 19605 NE 8th St. Camas, WA 98607 2. Issuer Name and Ticker or Trading Symbol Pediatric Services of America, Inc. (PSAI.OB) 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) N/A 4. Statement for Month/Year 12/2000 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) / / Director / / Officer (give title below) /X/ 10% Owner / / Other (specify below) N/A ___________________ 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 1 -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1. Title of Security (Instr. 3) Common Stock 2. Transaction Date(s) (Month/Day/Year) 12/14/2000 - 12/29/2000 3. Transaction Code (Instr. 8) Code: P V 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Date Amount(Shares) (A) or (D) Price per share --------- -------------- ---------- --------------- 12/14 7,000 (A) 4.875 12/15 2,000 (A) 4.8125 12/22 4,500 (A) 4.7847 12/26 19,500 (A) 4.8974 12/27 2,500 (A) 4.9375 12/28 5,000 (A) 4.8125 12/29 30,500 (A) 5.2654 5. Amount of Securities Beneficially Owned at End of Month (Instr. 3 and 4) 1,060,430 (15.9%) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) D: 1,030,430 I: 30,000 By Haredale, Ltd. P.O. Box N-4465, Nassau, New Providence, The Bahamas. 7. Nature of Indirect Beneficial Ownership (Instr. 4) Haredale, Ltd. owns, and Mr. Nierenberg has sole voting and dispositive power over, its 30,000 shares. 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) N/A 2. Conversion or Exercise Price of Derivative Security N/A 3. Transaction Date (Month/Day/Year) N/A 4. Transaction Code (Instr. 8) N/A 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) N/A 6. Date Exercisable and Expiration Date (Month/Day/Year) N/A 7. Title and Amount of Underlying Securities (Instr. 3 and 4) N/A 8. Price of Derivative Security (Instr. 5) N/A 9. Number of Derivative Securities Beneficially Owned at End of Month (Instr. 4) N/A 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) N/A 11. Nature of Indirect Beneficial Ownership (Instr. 4) N/A Explanation of Responses: N/A /s/ David Nierenberg 1/5/01 ---------------------------------------- ------- ** Signature of Reporting Person Date **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 provided is insufficient, see Instruction 6 for procedure. Potential person(s) 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-----