4 1 n_ps4210.txt FORM 4 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) 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) N/A 4. Statement for Month/Year October 2, 2002 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) 10/1 & 10/2/02 3. Transaction Code (Instr. 8) Code: P 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Date Amount(Shares) (A) or (D) Price per share --------- -------------- ---------- --------------- iii 10/1/02 1,200 (A) 5.60 10/2/02 6,300 (A) 5.55 iv 10/1/02 3,000 (A) 5.55 v 10/1/02 3,000 (A) 5.55 vi 10/1/02 10,000 (A) 5.56 5. Amount of Securities Beneficially Owned at Date of Report 919,730 (13.5%) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) i. D 876,230 by The D3 Family Fund, L.P. ii. I 20,000 by Haredale, Ltd. P.O. Box N-4465, Nassau, New Providence, The Bahamas. iii. I 7,500 by Olivier Roux Talisman Management Ltd.,37 Ixworth Place, London SW3, England. iv. I 3,000 by James Henry Hildebrandt c/o Bain & Company, Tenth Floor, One Pacific Place, 88 Queensway, Hong Kong. v. I 3,000 by Toxford Corporation P.O. Box 3048, St. Andrews House, Le Bordage, St. Peter Port, Guernsey, Channel Islands, British Isles. vi. I 10,000 by The David and Patricia Nierenberg 1993 Irrevocable Trust Lawrence K. Orr, Trinity Ventures, 3000 Sand Hill Rd., Bldg. 4, Suite 160, Menlo Park, CA 94025. 7. Nature of Indirect Beneficial Ownership (Instr. 4) Mr. Nierenberg has sole voting and dispositive power over the shares listed. 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 10/2/02 ---------------------------------------- ------- ** 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.