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OMB APPROVAL
- ------ U.S. SECURITIES AND EXCHANGE COMMISSION OMB Number 3235-0362
FORM 5 Washington, D.C. 20549 Expires: September 30, 1998
- ------ Estimated average
burden hours per
response........ 1.0
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[_] Check this box if no longer ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
subject to Section 16. Form 4
or Form 5 obligations may Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section
continue. See Instruction 1(b). 17(a) of the Public Utility
[_] Form 3 Holdings Reported Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of
[_] Form 4 Transactions Reported 1940
(PRINT OR TYPE RESPONSES)
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1. Name and Address of Reporting Person* 4. Statement for Month/Year
Chastain R. Ernest Year Ending 12/31/98
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(Last) (First) (Middle) 5. If Amendment, Date of Original
(Month/Year)
c/o InfoCure Corporation
1765 The Exchange, Suite 450 -------------------------------------------------------
- ------------------------------------------------------- 6. Relationship of Reporting Person to Issuer
(Street) (Check all applicable)
Atlanta Georgia 30339 [_] Director [_] 10% Owner
- ------------------------------------------------------- [X] Officer (give title [_] Other (specify
(City) (State) (Zip) below) below)
- ------------------------------------------------------- Vice-President - Sales & Marketing
2. Issuer Name and Ticker or Trading Symbol -------------------------------------------------------
7. Individual or Joint/Group Filing
InfoCure Corporation (INCX) (Check Applicable Line)
- ------------------------------------------------------- [X] Form filed by One Reporting Person
3. IRS or Social Security Number of Reporting [_] Form filed by More than One Reporting Person
Person (Voluntary) -------------------------------------------------------
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TABLE I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year)
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3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
Code
Amount (A) or (D) Price
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5. Amount of Securities Beneficially Owned at End of 6. Ownership Form: Direct (D) or Indirect (I)
Issuer's Fiscal Year (Instr. 3 and 4) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
* If the Form is filed by more than one reporting person, see Instructions 4(b)(v). SEC 2270 (7/96)
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1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security
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Stock Option (Right to Buy) $ 9.31
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Stock Option (Right to Buy) $11.63
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Stock Option (Right to Buy) $20.00
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3. Transaction Date (Month/Day/Year) 4. Transaction Code (Instr. 8)
- ------------------------------------------------------- Code
12/2/97
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10/23/98 A5
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12/2/98 A
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A
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5. Number of Derivative Securities Acquired (A) or 6. Date Exercisable and Expiration Date
Disposed of (D) (Instr. 3, 4 and 5) (Month/Day/Year)
(A) (D) Date Exercisable Expiration Date
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50 12/2/01 12/2/07
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2,006 (1) 10/23/98
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50 12/2/02 12/2/08
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7. Title and Amount of Underlying Securities 8. Price of Derivative Security (Instr. 5)
(Instr. 3 and 4)
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Title Amount or Number of Shares
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Common Stock 50
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Common Stock 2,006
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Common Stock 50
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- ------------------------------------------------------- 10. Ownership Form of Derivative Security. Direct (D)
or Indirect (I) (Instr. 4)
9. Number of Derivative Securities Beneficially Owned
at End of Year (Instr. 4) -------------------------------------------------------
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50 D
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2,006 D
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50 D
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Explanation of Responses:
(1) As of 10/23/98 exercisable as to 501 shares; as of 10/23/99 exercisable as to 1,002 shares; as of 10/23/01 exercisable as to
1,504 shares; as of 10/23/02 exercisable as to 2,006 shares.
**Intentional misstatements or omissions of fact constitute Federal Criminal
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 7811(a).
Note: File three copies of this Form, one of which must be manually signed.
/s/ R. Ernest Chastain
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** Signature of Reporting Person
R. Ernest Chastain
February 15, 1999
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Date
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