-----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, AsloZhSUcV6EEKOARQ53b4rKKLLOySGpfWjy4sMu8zhUTj4c7LwfOJdmWutaNo/z fxO1DmgaQm4TDBFzejf+iA== 0000898430-01-000558.txt : 20010223 0000898430-01-000558.hdr.sgml : 20010223 ACCESSION NUMBER: 0000898430-01-000558 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001231 FILED AS OF DATE: 20010214 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: DAVITA INC CENTRAL INDEX KEY: 0000927066 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 510354549 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 001-04034 FILM NUMBER: 1539121 BUSINESS ADDRESS: STREET 1: 21250 HAWTHORNE BLVD STREET 2: SIE 800 CITY: TORRANCE STATE: CA ZIP: 90503-5517 BUSINESS PHONE: 3107922600 MAIL ADDRESS: STREET 1: 21250 HAWTHORNE BLVD SUITE 800 STREET 2: 21250 HAWTHORNE BLVD SUITE 800 CITY: TORRANCE STATE: CA ZIP: 90503-5517 FORMER COMPANY: FORMER CONFORMED NAME: TOTAL RENAL CARE HOLDINGS INC DATE OF NAME CHANGE: 19950524 FORMER COMPANY: FORMER CONFORMED NAME: TOTAL RENAL CARE INC DATE OF NAME CHANGE: 19940719 COMPANY DATA: COMPANY CONFORMED NAME: MASSRY SHAUL G CENTRAL INDEX KEY: 0001069431 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] DIRECTOR STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: TOTAL RENAL CARE HOLDINGS INC STREET 2: 21250 HAWTHORNE BLVD STE 800 CITY: TORRANCE STATE: CA ZIP: 90503 BUSINESS PHONE: 3107922600 5 1 0001.txt FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 5 OMB APPROVAL ----------------------------- [_] Check this box if no longer OMB NUMBER: 3235-0362 subject to Section 16. Form 4 Expires: December 31, 2001 or Form 5 obligations may Estimated average burden continue. SEE Instruction 1(b). hours per response ...... 1.0 ----------------------------- [_] Form 3 Holdings Reported [_] Form 4 Transaction Reported ANNUAL 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 Massry Shaul G. - -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o DaVita Inc., 21250 Hawthorne Blvd. - -------------------------------------------------------------------------------- (Street) Torrance CA 90503 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol DaVita Inc. (DVA) - -------------------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Year December 31, 2000 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Day/Year) - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) X Director 10% Owner ----- ------ Officer (give Other (Specify ----- title below) ------ below) - --------------------------------------------------------------------------------
Table 1 -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1. Title of Security 2. Trans- 3. Trans- 4. Secuirties Acquired (A) 5. Amount of 6. Ownership 7. Nature (Instr. 3) action action or Disposed of (D) Securities Form: of Indirect Date Code Beneficially Direct Beneficial (Instr. 8) (Instr. 3,4 and 5) Owned at End (D) or Ownership (Month/ -------------------------- Of Issuer's Indirect (Instr. 4) Day/ Amount (A) or Price Fiscal Year (I) Year) (D) (Instr. 3 and 4) (Instr. 4) - -------------------------- ---------- ------ ---- -------- ------ ------ ---------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ -------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) (Over) SEC 2270 (3/91) FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security 2. Conversion 3. Transaction 4. Transacation 5. Number of Derivative 6. Date Exercisable (Instr. 3) or Exercise Date Code Securities Acquired (A) and Expiration Price of (Month Day (Instr. 8) or Disposed of (D) Date Derivative Year) (Instr. 3, 4, and 5) (Month, Day Security Year) -------------------------- ------------------- (A) (D) Date Expiration Exer- Date cisable - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- Options (16b-3 Plan) $6.5625 1/6/00 A 25,000 (1) 1/6/05 - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- Options (16b-3 Plan) $2.6875 3/29/00 A 12,000 (2) 3/29/05 - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- Options (16b-3 Plan) $6.4375 7/25/00 A 13,000 (3) 7/25/05 - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- -------------------
7. Title and Amount of 8. Price of Derivative 9. Number of Derivative 10. Ownership of 11. Nature of the Underlying Securities Security (Instr. 5) Securities Beneficially Derivate Securitiy: Indirect Beneficial (Instr. 3 AND 4) Owned at End of Year Direct (D) or Ownership (Instr. 4) Instr. 4) Indirect (I) (Instr. 4) - ------------------------ Title Amount or Number of Shares - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ Common Stock 25,000 25,000 D - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ Common Stock 12,000 12,000 D - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ Common Stock 13,000 13,000 D - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------
Explanation of Responses: (1) The indicated option vests at 25% per year such that 6,250 shares shall vest on each of the following dates: 12/17/01;12/17/02;12/17/03, and 12/17/04. If DaVita's stock price closes at $11.41 or above for 10 of any 20 consecutive trading days, the last quarter-tranche (the 25% that would have vested on 12/17/04) vests immediately. (2) The indicated options vest at 25% per year such that 3,000 shares vest, or have vested, on each of the following dates: 3/29/01, 3/29/02, 3/29/03, and 3/29/04. If DaVita's stock price closes at $5.01 or above for 10 of any 20 consecutive trading days, the last quarter-tranche (25% that would have vested on 3/29/04) vests immediately. (3) The indicated option vests at 25% per year such that 3,250 shares shall vest on each of the following dates: 7/25/01; 7/25/02; 7/25/03; and 7/25/04. If DaVita's stock price closes at $12.00 or above for 10 of any 20 consecutive trading days, the last quarter-tranche (the 25% that would have vested on 7/25/04) vests immediately. 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 persons 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. /s/ Shaul G. Massry February 13, 2001 _______________________________ _________________ 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). Page 2 SEC 2270 (3/91) -----END PRIVACY-ENHANCED MESSAGE-----