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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
RFPS MANAGEMENT CO I LP 2170 Piedmont Road, N.E. Atlanta, GA 30324 |
X | |||
LOR INC 2170 Piedmont Road, N.E. Atlanta, GA 30324 |
X | |||
RFA MANAGEMENT CO LLC 2170 PIEDMONT ROAD, N.E. ATLANTA, GA 30324 |
X |
Glenn P. Grove, Jr., Asst. Secretary of Manager | 10/10/2003 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | On October 10, 2003, O. Wayne Rollins contributed 112,500 shares (which shares reflect a 1.5 for 1 stock split which was effective as of February 10, 2003) to RFPS Management Company I, L.P. No consideration was given for the shares. |
(2) | These shares are held by RFPS Management Company I, L.P. ("RFPS"). RFA Management Company, LLC is the general partner of RFPS ("General Partner") and LOR, Inc. is the manager of the General Partner (the "Manager"), both of whom are filing this Form 4 together with RFPS as a group for purposes of Section 13(d) of the Exchange Act. Each of the General Partner and the Manager disclaim beneficial ownership of the shares exceeding its pecuniary interest, and this report shall not be deemed an admission that each of General Partner and the Manager is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. |