| Form 4 ¨ Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
UNITED STATES SECURITIES AND
EXCHANGE COMMISSION Washington, DC 20549 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 |
OMB APPROVAL OMB Number: 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response . . . 0.5 |
| (Print or Type Responses) | ||||||
| 1. |
Name and Address of Reporting Person* | |||||
| Shapiro
L. Dennis | ||||||
| | ||||||
| (Last)
(First)
(Middle) | ||||||
| 24 Essex Road | ||||||
| | ||||||
|
(Street) | ||||||
| Chestnut
Hill MA
02467 | ||||||
| | ||||||
| (City)
(State)
(Zip) | ||||||
| 2. |
Issuer Name and Ticker or Trading Symbol | |||||
| Lifeline Systems, Inc. (LIFE) |
||||||
| 3. |
I.R.S. Identification Number of Reporting Person, if an entity (voluntary) | |||||
| 4. |
Statement for Month/Day/Year | |||||
| 11/25/2002 | ||||||
| 5. |
If Amendment, Date of Original (Month/Day/Year) | |||||
| 6. |
Relationship of Reporting Person(s) to Issuer (Check all applicable) | |||||
| x Director x 10% Owner ¨ Officer (give title below) ¨ Other (specify below) | ||||||
| 7. |
Individual or Joint/Group Filing (Check Applicable Line) x Form filed by One Reporting Person ¨ Form filed by More than One Reporting Person | |||||
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||
| 1. |
Title of Security (Instr. 3) | |||||
| Common Stock |
||||||
| 2. |
Transaction Date (Month/Day/Year) | |||||
| 11/25/02 |
||||||
| 2A. |
Deemed Execution Date, if any (Month/Day/Year) | |||||
| 3. |
Transaction Code (Instr. 8) | |||||
| Code |
V | |||||
| G
V |
||||||
| 4. |
Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | |||||
| Amount
(A) or (D) |
Price | |||||
| 100,000
D |
$0 | |||||
| 5. |
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
| |||||
| 452,875 |
||||||
| 6. |
Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | |||||
| D |
||||||
| 7. |
Nature of Indirect Beneficial Ownership (Instr. 4) | |||||
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||
| 1. |
Title of Security (Instr. 3) | |||||
| Common Stock |
||||||
| 2. |
Transaction Date (Month/Day/Year) | |||||
| 2A. |
Deemed Execution Date, if any (Month/Day/Year) | |||||
| 3. |
Transaction Code (Instr. 8) | |||||
| Code |
V | |||||
| 4. |
Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | |||||
| Amount
(A) or (D) |
Price | |||||
| 5. |
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
| |||||
| 35,312 |
||||||
| 6. |
Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | |||||
| I |
||||||
| 7. |
Nature of Indirect Beneficial Ownership (Instr. 4) | |||||
| By Wife |
||||||
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||
| 1. |
Title of Security (Instr. 3) | |||||
| Common Stock |
||||||
| 2. |
Transaction Date (Month/Day/Year) | |||||
| 2A. |
Deemed Execution Date, if any (Month/Day/Year) | |||||
| 3. |
Transaction Code (Instr. 8) | |||||
| Code |
V | |||||
| 4. |
Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | |||||
| Amount
(A) or (D) |
Price | |||||
| 5. |
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
| |||||
| 17,062 |
||||||
| 6. |
Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | |||||
| I |
||||||
| 7. |
Nature of Indirect Beneficial Ownership (Instr. 4) | |||||
| By children |
||||||
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||
| 1. |
Title of Security (Instr. 3) | |||||
| Common Stock |
||||||
| 2. |
Transaction Date (Month/Day/Year) | |||||
| 2A. |
Deemed Execution Date, if any (Month/Day/Year) | |||||
| 3. |
Transaction Code (Instr. 8) | |||||
| Code |
V | |||||
| 4. |
Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | |||||
| Amount
(A) or (D) |
Price | |||||
| 5. |
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
| |||||
| 4,124 |
||||||
| 6. |
Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | |||||
| I |
||||||
| 7. |
Nature of Indirect Beneficial Ownership (Instr. 4) | |||||
| As trustee for children |
||||||
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||
| 1. |
Title of Security (Instr. 3) | |||||
| Common Stock |
||||||
| 2. |
Transaction Date (Month/Day/Year) | |||||
| 11/25/02 |
||||||
| 2A. |
Deemed Execution Date, if any (Month/Day/Year) | |||||
| 3. |
Transaction Code (Instr. 8) | |||||
| Code |
V | |||||
| G
V |
||||||
| 4. |
Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | |||||
| Amount
(A) or (D) |
Price | |||||
| 100,000
A |
$0 | |||||
| 5. |
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
| |||||
| 166,000 |
||||||
| 6. |
Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | |||||
| I |
||||||
| 7. |
Nature of Indirect Beneficial Ownership (Instr. 4) | |||||
| As co-trustee |
||||||
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||
| 1. |
Title of Security (Instr. 3) | |||||
| Common Stock |
||||||
| 2. |
Transaction Date (Month/Day/Year) | |||||
| 2A. |
Deemed Execution Date, if any (Month/Day/Year) | |||||
| 3. |
Transaction Code (Instr. 8) | |||||
| Code |
V | |||||
| 4. |
Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | |||||
| Amount
(A) or (D) |
Price | |||||
| 5. |
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
| |||||
| 15,735 |
||||||
| 6. |
Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | |||||
| I |
||||||
| 7. |
Nature of Indirect Beneficial Ownership (Instr. 4) | |||||
| By wife as trustee for various family members |
||||||
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | ||||||
| 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) | |||||
| Code |
V | |||||
| 5. |
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | |||||
| (A) |
(D) | |||||
| 6. |
Date Exercisable and Expiration Date (Month/Day/Year) | |||||
| Date Exercisable |
Expiration Date | |||||
| 7. |
Title and Amount of Underlying Securities (Instr. 3 and 4) | |||||
| Title |
Amount or Number of Shares | |||||
| 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 Securities: Direct (D) or Indirect (I) (Instr. 4) | |||||
| 11. |
Nature of Indirect Benefical Ownership (Instr. 4) | |||||
| /s/ Sheryl Sigrist UPA L. Dennis Shapiro |
11/26/02 | |
| **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).
|
Note: |
File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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