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OMB APPROVAL
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OMB Number: 3235-0287
Expires: December 31, 2001
Estimated average burden
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 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(f) of the Investment Company Act of 1940
[_] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
(Print or Type responses)
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1. Name and Address of Reporting Person*
Nowakowski Susan R.
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(Last) (First) (Middle)
c/o AMN Healthcare Services, Inc.
12235 El Camino Real, Suite 200
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(Street)
San Diego CA 92130
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
AMN Healthcare Services, Inc. ("AHS")
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
January 2002
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
Chief Operating Officer, Executive Vice
President and Secretary
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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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6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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Common Stock, par value
$.01 per share 300 D
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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).
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 CONTROL NUMBER.
(Over)
SEC 1474 (3/99)
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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10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Stock Option $22.98 1/17/02 A V 60,000 (1) 1/17/12 Common Stock 60,000 60,000 D
(Right to Buy)
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Stock Option $3.80 11/19/97 (2) 11/19/09 Common Stock 339,350 339,350 D
(Right to Buy)
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Stock Option $3.80 11/20/00 (3) 12/31/09 Common Stock 202,006 202,006 D
(Right to Buy)
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Stock Option $6.68 12/13/00 (4) 12/31/09 Common Stock 119,445 119,445 D
(Right to Buy)
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Explanation of Responses:
(1) The options to purchase shares of Common Stock were issued pursuant to the
AMN Healthcare Services, Inc 2001 Stock Option Plan and become exercisable
in four equal installments, for the right to purchase 15,000 shares on each
of January 17, 2003, 2004, 2005, and 2006.
(2) The options to purchase shares of Common Stock become exercisable in four
equal installments, for the right to purchase 84,837.5 shares on each of
December 31, 2001, May 14, 2002, December 31, 2002, and December 31, 2003.
(3) The options to purchase shares of Common Stock become exercisable in four
equal installments, for the right to purchase 50,501.5 shares on each of
December 31, 2001, May 14, 2002, December 31, 2002, and December 31, 2003.
(4) The options to purchase shares of Common Stock become exercisable in four
equal installments, for the right to purchase 29,861.25 shares on each of
May 14, 2002, December 31, 2002, December 31, 2003, and December 31, 2004.
/s/ Susan R. Nowakowski February 7, 2002
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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 provided 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 control number.
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