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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 | |
PETERSEN AUDREY M 10560 DR. MARTIN LUTHER KING JR. ST N ST. PETERSBURG, FL 33716-3718 |
X |
By: Robert L. Paver, Attorney-in-Fact For: Audrey M. Petersen | 10/21/2004 | |
**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) | This transaction was effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person. |
(2) | Mrs. Petersen is a co-trustee of the William E. Morean Residual Trust and has shares voting and dispositive power over the share held by such trust. |
(3) | Mrs. Petersen is a trustee of the Audrey Petersen Revocable Trust and has voting and dispositive power over the shares held by such trust. |
(4) | Audrey M. Petersen's husband, Alfred D. Petersen, is a trustee of the Alfred D. Petersen Revocable Trust and has voting and dispositive power over the shares held by such trust. |
(5) | Mrs. Petersen is the President of Morean-Petersen, Inc., the sole general partner of the Morean Limited Partnership, a North Carolina limited partnership, and has shares voting and dispositive power of the shares held by such limited partnership. |
(6) | Mrs. Petersen is a director of the Morean Petersen Foundation, Inc., a private charitable foundation, and may be deemed to have shared voting and dispositive powers over shares held by the foundation. |