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OMB Number: 3235-0287
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 4
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(h) of the Investment Company Act of 1940
|_| Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
(Print of Type Responses)
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1. Name and Address of Reporting Person*
Falk Michael S.
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(Last) (First) (Middle)
830 Third Avenue, 4th Floor
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(Street)
New York New York 10022
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Proxymed, Inc./PILL
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3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary)
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4. Statement for Month/Day/Year
3/06/03
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5. If Amendment, Date of Original (Month/Day/Year)
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|X| Director |_| 10% Owner
|_| Officer (give title below) |_| Other (specify below)
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7. Individual or Joint/Group Filing (Check Applicable line)
|X| Form Filed by One Reporting Person
|_| Form Filed by More than One Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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5.
Amount of 6.
4. Securities Owner-
Securities Acquired (A) or Beneficially ship
2A. 3. Disposed of (D) Owned Form: 7.
2. Deemed Transaction (Instr. 3, 4 and 5) Following Direct Nature of
Trans- Execution Code ------------------------------- Reported (D) or Indirect
1. action Date, if (Instr. 8) (A) Transaction(s) Indirect Beneficial
Title of Security Date any ------------ or (Instr. 3 & (I) Ownership
(Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V Amount (D) Price Instr.4) (Instr.4) (Instr.4)
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Common Stock March 4, P 1,900 A $9.50 D
2003
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Common Stock March 4, P 1,000 A $9.55(1) I
2003
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Common Stock March 4, P 1,000 A $9.55(2) 424,674(3) I
3003
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
*If the form is filed by more than one reporting person, see
Instruction 4(b)(v).
PERSONS WHO RESPOND TO THE COLLECTION OF INFORMATION
CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS (Over)
THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER. SEC 1474 (9/02)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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9.
Number 10.
of Owner-
deriv- ship
ative Form
2. Secur- of
Conver- 5. 7. ities Deriv- 11.
sion Number of Title and Amount Bene- ative Nature
or Derivative 6. of Underlying 8. ficially Secur- of
Exer- 3A. 4. Securities Date Securities Price Owned ity: In-
cise Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Follow- Direct direct
Price 3. Execut- action or Disposed Expiration Date ---------------- Deriv- ing (D) or Bene-
1. of Trans- ion Code of(D) (Month/Day/Year) Amount ative Reported In- ficial
Title of Deriv- action Date if (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner-
Derivative ative Date any 8) 4 and 5) Date Expira- Number ity action(s) (I) ship
Security Secur- (mm/dd/ (mm/dd/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity yy) yy) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Explanation of Responses:
(1) On March 4, 2003 the Mikaela Falk Trust purchased 1,000 shares of Common
Stock of the Issuer. Mr. Falk's child is the beneficiary of the trust, and
Mr. Falk's wife is the trustee.
(2) On March 4, 2003 the Gianna Falk Trust purchased 1,000 shares of Common
Stock of the Issuer. Mr. Falk's child is the beneficiary of the trust, and Mr.
Falk's wife is the trustee.
(3) Includes 19,402 shares of Common Stock held by Commonwealth Associates, LP,
which Falk is a control person, 16,278 shares of Common Stock held by ComVest
Capital Partners, LLC, which Falk is a managing member, 248,446 shares of Common
Stock and 6,635 Warrants which upon exercise convert into 6,635 shares of Common
Stock held by Commonwealth Associates Liquidation, LLC, which Falk is a
controlling member, 5,000 shares of Common Stock held by the Falk Family
Foundation, which Falk is the trustee, 1,000 shares of Common Stock held by the
Mikaela Falk Trust, and 1,000 shares of Common Stock held by the Gianna Falk
Trust.
/s/ Michael S. Falk March 6, 2003
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**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).
Note: File three copies of this Form, one of which must be manually signed.
If space 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.
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