-----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, GtJ4WH3bTa5bRGlm4e6YGtLhbMwy5gOUU+IfhcmyPLR7gvJPng2DsLkJTjonwpB+ cSFm/C0CsQKxZZl+y6t0Jw== 0000906337-01-000004.txt : 20010228 0000906337-01-000004.hdr.sgml : 20010228 ACCESSION NUMBER: 0000906337-01-000004 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000930 FILED AS OF DATE: 20010226 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PROXYMED INC /FT LAUDERDALE/ CENTRAL INDEX KEY: 0000906337 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 650202059 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-22052 FILM NUMBER: 1554275 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: POLAN BERTRAM CENTRAL INDEX KEY: 0001027559 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR STATE OF INCORPORATION: FL FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 2501 DAVIE ROAD, SUITE 230 CITY: FORT LAUDERDALE STATE: FL ZIP: 33317 BUSINESS PHONE: 9544731001 5 1 0001.txt FORM 5 - SEPTEMBER 2000 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). ( ) Form 3 Holdings Reported (X) Form 4 Transactions Reported 1. Name and Address of Reporting Person Polan, Bertram J 2555 Davie Road, Suite 110 Fort Lauderdale, FL 33317 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 September 2000 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director ( ) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) Director 7. Individual or Joint/Group Reporting (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 | |Date |Code| | Beneficially |(D)or | | | | | | A/| | Owned at |Indir | | | | | Amount | D | Price | End of Year |ect(I)| | ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ 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 |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise Pr | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership | |ice 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 | | | Amount | |ble | | | |Year |(I)| | ___________________________________________________________________________________________________________________________________| Stock Options |$1.22 |09/19|A |66,668 |A |09/19|09/19|Common Stock|66,668 |$1.22 | |D | | | |/00 | | | |/01 |/10 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Stock Options |$1.22 |09/19|A |66,666 |A |09/19|09/19|Common Stock|66,666 |$1.22 | |D | | | |/00 | | | |/02 |/10 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Stock Options |$1.22 |09/19|A |66,666 |A |09/19|09/19|Common Stock|66,666 |$1.22 |290,000 |D | | | |/00 | | | |/03 |/10 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________|
Explanation of Responses: SIGNATURE OF REPORTING PERSON Bertram J. Polan DATE February 26, 2001 -----END PRIVACY-ENHANCED MESSAGE-----