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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, Section 17(a) of the Public Utility Holding Company Act of 1935 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 | |
POPE JOHN C 810 SOUTH RIDGE ROAD LAKE FOREST, IL 60045 |
X |
/s/ JOHN C. POPE | 01/03/2005 | |
**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) | Represented by deferred "stock units" (phantom stock) credited under the Per-Se Technologies, Inc. Deferred Stock Unit Plan (the "Plan"). The stock units are to be settled in Common Stock on a 1-for-1 basis, in one installment as soon as administratively feasible following the date on which the Reporting Person ceases to be a Director of the Issuer, with any fractional shares payable in cash. |
(2) | Average closing price of the Common Stock for the five business days prior to January 3, 2005, the date on which the stock units were credited to the Reporting Person's account under the Plan. |
(3) | Reflects deferral under the Plan and conversion into stock units of $27,000, comprising 100% of the Reporting Person's cash compensation otherwise payable for Board and Committee service during the period from September 7, 2004, through December 6, 2004 (the 2nd Quarter of the 2004-05 Board Year). |