-----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, UL9uVh6qR7jIyTyCPXAfTThiiqLV8gnHPcDOS6lVQjj+XhqnMJRo4PIxwL5uVvil FX2kHzb1cFDdSJzuxWIZPw== 0000906337-96-000013.txt : 19961210 0000906337-96-000013.hdr.sgml : 19961210 ACCESSION NUMBER: 0000906337-96-000013 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19961209 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PROXYMED INC /FT LAUDERDALE/ CENTRAL INDEX KEY: 0000906337 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-DRUG STORES AND PROPRIETARY STORES [5912] IRS NUMBER: 650202059 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22052 FILM NUMBER: 96677688 BUSINESS ADDRESS: STREET 1: 2501 DAVIE RD STE 230 CITY: FT LAUDERDALE STATE: FL ZIP: 33317-7424 BUSINESS PHONE: 3054731001 FORMER COMPANY: FORMER CONFORMED NAME: HMO PHARMACY INC DATE OF NAME CHANGE: 19930601 COMPANY DATA: COMPANY CONFORMED NAME: DRAGAN CAROL CENTRAL INDEX KEY: 0001027564 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER STATE OF INCORPORATION: FL FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 2501 DAVIE ROAD, SUITE 230 CITY: FORT LAUDERDALE STATE: FL ZIP: 33317 BUSINESS PHONE: 9544731001 4 1 FORM 4 - NOVEMBER 1996 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 1. Name and Address of Reporting Person Dragan, Carol 110 S.W. 91st Avenue Apt. 308 Plantation, FL 33324 Broward 2. Issuer Name and Ticker or Trading Symbol ProxyMed, Inc. PILL 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year November 1996 5. If Amendment, Date of Original (Month/Year) 09/30/96 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Executive Vice President 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 I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1. Title of Security |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | | Transaction | or Disposed of (D) | Securities |ect | Beneficial Ownership | | | | | Beneficially |(D)or | | | | | | | A/| | Owned at |Indir | | | Date |Code|V| Amount | D | Price | End of Month |ect(I)| | ___________________________________________________________________________________________________________________________________| | | | | | | | | | | N/A | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of Derivative |2.Con- |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of| Security |version |Transaction | rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect | |or Exer | | | rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership | |Price of| | | posed of(D) |Day/Year) | |rity |Benefi |or | | |Deriva- | | | |Date |Expir| | |ficially |Ind| | |tive | | | | A/|Exer-|ation| Title and Number | |Owned at |ire| | |Secu- | | | | | D |cisa-|Date | of Shares | |End of |ct | | |rity |Date |Code|V| Amount | |ble | | | |Month |(I)| | ___________________________________________________________________________________________________________________________________| Employee Stock Option |$6.94 |11/11|A * |V|6,600 |A |01/01|11/11|Common Stock|6,600 | |6,600 |D | | (Right to Buy) | |/96 | | | | |/97 |/06 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$6.94 |11/11|A * |V|5,400 |A |10/01|11/11|Common Stock|5,400 | |12,000 |D | | (Right to Buy) | |/96 | | | | |/97 |/06 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$6.94 |11/11|A * |V|24,000 |A |10/01|11/11|Common Stock|24,000 | |36,000 |D | | (Right to Buy) | |/96 | | | | |/98 |/06 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$6.94 |11/11|A * |V|24,000 |A |09/30|11/11|Common Stock|24,000 | |60,000 |D | | (Right to Buy) | |/96 | | | | |/99 |/06 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | ___________________________________________________________________________________________________________________________________|
Explanation of Responses: * Cancellation of option in connection with grant of replacement option. SIGNATURE OF REPORTING PERSON Carol Dragan DATE December 5, 1996 -----END PRIVACY-ENHANCED MESSAGE-----