4 1 form4bathgate.txt FORM 4 BATHGATE FORM 4 [x] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may con- tinue. See Instruction 1(b). U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C., 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Sec. 16(a) of the Securities Exchange Act of 1934, Sec. 17(a) of the Public Utility Holding Company Act of 1935 or Sec. 30(f) of the Investment Company Act of 1940.
------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting person* 2. Issuer Name and Ticker or Trading 6.Relationship of Reporting Person to Issuer Symbol (Check all applicable) Bathgate Steven M Birner Dental Management Svcs, Inc. (BDMS) Director 10% Owner ---------------------------------------------------------------- --------------- ------ ----- (Last) (First) (Middle) 3. IRS or Social Security Number of Reporting Person (Voluntary) Officer (give title below) X Other ------ ----- 3801 E. Florida Ave. Ste 508 Former Director ------------------------------------------------------------------------------------------------------------------------------------ 7. Individual or Joint/Group Filing (Street) 4. Statement for Month/Year 12/18/02 __X__ Form filed by One Reporting Person -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) _____ Form filed by More than One Reporting N/A Person ----------------------------------------------------------------------------------------------------------------------------------- Denver CO 80210 ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Transaction 3. Transaction 4. Securities Acquired (A)5.Amount of 6. Ownership 7.Nature of (Instr. 3) Date Code (Instr.8) or Disposed of (D) ; Securities Form: Direct (D) Indirect Month/Day/Year) (Instr. 3, 4,and 5) Beneficially or Indirect (I) Beneficial Owned at end of Instr. 4) Ownership Month (Instr. 3 (Instr. 4) and 4) --------------------- ---------------- ---------------- ------------------------------ ---------- ----------- ----------- Code V Amount (A) or (D) Price --------------------- ---------------- ---------- ----- -------- ----------- ---------- ---------- ----------- ----------- Common Stock 18,753 D --------------------- ---------------- ---------- ----- -------- ----------- --------- ---------- ----------- ----------- Common Stock 75,725 I by wife --------------------- ---------------- ---------- ----- -------- ----------- --------- ---------- ----------- ----------- Common Stock 500 I by son, Jonathan --------------------- ---------------- ---------- ----- -------- ----------- --------- ---------- ----------- ----------- Common Stock 500 I by son, Charles --------------------- ---------------- ---------- ----- -------- ----------- --------- ---------- ----------- ----------- Common Stock 500 I by daughter, Allison --------------------- ---------------- ---------- ----- -------- ----------- --------- ---------- ----------- ----------- Common Stock 2,000 I by son, Marc --------------------- ---------------- ---------- ----- -------- ----------- --------- ---------- ----------- ----------- *If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder. Report on a separate line for each class of securities beneficially owned directlyor indirectly. (Print of type response) (Over)
FORM 4 (continued)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (eg., puts, calls, warrants, options, convertible securities) ------------ ---------- ------------ ----------- ------------ ---------------------- --------------------- 1. Title of 2.Conver- 3. Transac- 4. Transac- 5. Number of 6. Date Exercisable 7. Title and Amount Derivative sion or tion Date tion Code Derivative and Expiration of Underlying Securitiy Exer- (Month/Day/ (Instr. 8) Securities Date (Month/Day/ Securities (Instr. 3) cise Price Year) Acquired (A) Year) (Instr. 3 and 4) of Deriva- or Disposed tive of (D) Security (Instr. 3, 4, and 5) ------------ ---------- ------------ ----------- ------------ ---------- ---------- ---------- --------- Date Expira- Title Amount or Exer- tion Date Number of cisable Shares ------------ ---------- ------------ ------- --- --- -------- -------- ---------- ---------- --------- Code V (A) (D) ------------ ---------- ------------ ------- --- --- -------- -------- ---------- ---------- --------- Stock Options (right to buy) $2.00 12/18/02 E 5,000 6/22/02 03/18/03 Common Stock 5,000 ------------ ---------- ------------ ------- --- --- -------- -------- ---------- ---------- --------- Stock Options (right to buy) $11.00 03/18/03 Common Stock ------------ ---------- ------------ ------- --- --- -------- -------- ---------- ---------- --------- Stock Options (right to buy) $15.00 03/18/03 Common Stock ------------ ---------- ------------ ------- --- --- -------- -------- ---------- ---------- --------- Stock Options (right to buy) $528.00 03/18/03 Common Stock ------------ ---------- ------------ ------- --- --- -------- -------- ---------- ---------- ---------
Table II (continued) ------------ ---------- ---------- ------------ ------------ 1. Title of 8. Price 9. Number 10. Owner- 11. Nature Derivative of of Deriva- ship of De- of Securitiy Derivative tive rivative Indirect (Instr. 3) Security Securi- Security; Beneficial and ties Direct (D) Ownership (Instr.5) Benefi- or (Instr. 4) cially Indirect Owned at (I) end of (Instr. 4) Month (Instr. 4) ------------ ---------- ----------- ----------- ------------ Stock Options (right to buy) $0 5,000 D ------------ ---------- ----------- ----------- ------------ Stock Options (right to buy) 1,250 D ------------ ---------- ----------- ----------- ------------ Stock Options (right to buy) 2,500 D ------------ ---------- ----------- ----------- ------------ Stock Options (right to buy) 2,500 D ------------ ---------- ----------- ----------- ------------ Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a) /s/ Steven M. Bathgate January 7, 2003 ---------------------------- --------------- ** Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure.