-----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, FUpEjYz4MvVt4pTVqx9mEIn0gAa1m+D4ywrYawD6Y/gnD7V9dnAuzd/1SitdT5EA pNuQNXVSUpvWO8HMDnaBRQ== /in/edgar/work/20000807/0000906337-00-000018/0000906337-00-000018.txt : 20000921 0000906337-00-000018.hdr.sgml : 20000921 ACCESSION NUMBER: 0000906337-00-000018 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000731 FILED AS OF DATE: 20000807 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PROXYMED INC /FT LAUDERDALE/ CENTRAL INDEX KEY: 0000906337 STANDARD INDUSTRIAL CLASSIFICATION: [7374 ] IRS NUMBER: 650202059 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-22052 FILM NUMBER: 686997 BUSINESS ADDRESS: STREET 1: 2555 DAVIE ROAD STREET 2: SUITE 110 CITY: FORT LAUDERDALE STATE: FL ZIP: 33317-7424 BUSINESS PHONE: 9544731001 FORMER COMPANY: FORMER CONFORMED NAME: HMO PHARMACY INC DATE OF NAME CHANGE: 19930601 COMPANY DATA: COMPANY CONFORMED NAME: HARDY A THOMAS CENTRAL INDEX KEY: 0001120713 STANDARD INDUSTRIAL CLASSIFICATION: [ ]OTHER IRS NUMBER: 650202059 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 12507 HUMMINGBIRD WAY CITY: SELLERSBURG STATE: IN ZIP: 47172 BUSINESS PHONE: 9544731001 MAIL ADDRESS: STREET 1: 12507 HUMMINGBIRD WAY CITY: SELLERBURG STATE: IN ZIP: 47172 4 1 0001.txt FORM 4 - 07/31/00 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 Hardy, A. Thomas 12507 Hummingbird Way Sellersburg, IN 47172 USA 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 07/31/00 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner ( ) Officer (give title below) (X) Other (specify below) Division Head 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)| | ___________________________________________________________________________________________________________________________________| Common Stock, $.001 par val|12/30/|P |V|240,950 |A |N/A |240,950 |I |Hardy Family LP | ue |98 | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ 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 |$11.75 |01/04|A |V|44,000 |A |01/04|01/04|Common Stock|44,000 |$11.75 |44,000 |D | | | |/99 | | | | |/99 |/09 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$11.00 |08/11|A |V|32,667 |A |08/11|08/11|Common Stock|32,667 |$11.00 |76,667 |D | | | |/99 | | | | |/00 |/04 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$11.00 |08/11|A |V|32,667 |A |08/11|08/11|Common Stock|32,667 |$11.00 |109,334 |D | | | |/99 | | | | |/01 |/04 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$11.00 |08/11|A |V|32,666 |A |08/11|08/11|Common Stock|32,666 |$11.00 |142,000 |D | | | |/99 | | | | |/02 |/04 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Series C 7% Conv. Pref|$1.00 |06/29|A |V|3,000 |A |N/A* |N/A |Common Stock|300,000|$1.00 |442,000 |I |Hardy Family| erred Stock | |/00 | | | | | | | | | | | | LP | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |$1.00** |06/29|A |V|150,000 |A |07/07|06/28|Common Stock|150,000|$1.00 |592,000 |I |Hardy Family| | |/00 | | | | |/01* |/05 | | | | | | LP | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$1.53 |07/11|A |V|100,000 |A |07/11|07/11|Common Stock|100,000|$1.53 |692,000 |D | | | |/00 | | | | |/01 |/10 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option | $1.53 |07/11|A |V|100,000 |A |07/11|07/11|Common Stock|100,000|$1.53 |792,000 |D | | | |/00 | | | | |/02 |/10 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$1.53 |07/11|A |V|100,000 |A |07/11|07/11|Common Stock|100,000|$1.53 |892,000 |D | | | |/00 | | | | |/03 |/10 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | ___________________________________________________________________________________________________________________________________|
Explanation of Responses: *Convertible Preferred and Warrant Shares are subject to a 12-month lockup, which may be extended an additional 12 months at the discretion of the Placement Agent. **Subject to anti-dilution adjustment as provided in the Warrant Agreement. SIGNATURE OF REPORTING PERSON A. Thomas Hardy DATE August 4, 2000 -----END PRIVACY-ENHANCED MESSAGE-----