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OMB APPROVAL
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OMB Number 3235-0104
Expires: April 30, 1997
Estimated average burden
hours per response ....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF 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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
MIELE MICHAEL S.
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(Last) (First) (Middle)
51 PARK STREET
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(Street)
MONTCLAIR NEW JERSEY 07042
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
11/02/00
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
LANDACORP INC. (LCOR)
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5 Relationship of Reporting Person to Issuer
(Check all applicable)
[X ] Director [ ] 10% Owner
[X ] Officer (give title below) [ ] Other (specify below)
SENIOR VICE PRESIDENT OF POPULATION MANAGEMENT
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6. If Amendment, Date of Original (Month/Year)
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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 Beneficially Owned
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr.5)
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<S> <C> <C> <C>
COMMON STOCK 1,056,875 D(1)
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
*If form is filed by more than one reporting person, see Instruction 5(b)(v).
(1) Includes 105,688 shares of common stock which are being held in escrow
pursuant to the terms of a certain Escrow Agreement among Landacorp, Inc.,
Imperial Bank, as Escrow Agent, Michael S. Miele and certain other parties
thereto.
<PAGE>
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Security Exer- tion of Derivative (I) Ownership
(Instr. 4) cisable Date Title Shares Security (Instr.5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
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Employee Stock Options
(right to buy) Immed. 1/1/09 Common Stock 44,500 $1.29 D
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Employee Stock Options
(right to buy) Immed. 8/20/10 Common Stock 89,000 $3.19 D
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Employee Stock Options
(right to buy) Immed. 10/30/10 Common Stock 197,790 $1.50 D
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</TABLE>
Explanation of Responses:
/s/Mathew B. Hoffman November 13, 2000
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**Signature of Reporting Person Date
Mathew B. Hoffman, Esq. Attorney-In-Fact
**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 are required to respond unless the form displays a
currently valid OMB Number.
