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FORM 4 OMB APPROVAL
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[ ] Check this box if no longer OMB Number 3235-0287
subject to Section 16. Form 4 Expires: September 30, 1998
or Form 5 obligations may Estimated average burden
continue. See Instruction 1(b). hours per response............. 0.5
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 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(f) of the
Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Ryberg Jean Edna
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(Last) (First) (Middle)
9244 W. Wescott Drive
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(Street)
Peoria AZ 85382
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(City (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Frontier Adjusters of America, Inc. (FAJ)
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3. IRS Or Social Security
Number of Reporting
Person (Voluntary)
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4. Statement for Month/Year
December 1999
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5. If Amendment,
Date of Original
(Month/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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<PAGE>
Form 4 (continued)
<TABLE>
<CAPTION>
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TABLE I--NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature of
(Instr. 3) action action or Disposed of (D) Securities ship Indirect
Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial
(Month/ (Instr. 8) Owned at Direct Owner-
Day/ ---------- ------------------------ End of Month (D) or ship
Year) (A) or (Instr. 3 and 4) Indirect(I) (Instr. 4)
Code V Amount (D) Price (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock 12/17/99 G 13,000 D 1.125 57,412 D
40,548 I (1)
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Table II--DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Derivative
Security (Instr. 3) sion or action tion Securities Acquired
Exercise Date Code (A) or Disposed
Price of (Month/ (Instr. 8) of (D)(Instr. 3,4, and 5)
Derivative Day/ ----------- -------------------------
Security Year) Code V (A) (D)
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6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10.Owner- 11. Nature
cisable and Underlying Securities of of Deriv- ship of
Expiration (Instr. 3 and 4) Deriv- ative Form of Indirect
Date (Month/ ative Securities Deriv- Benefi-
Day/Year) Security Bene- ative cial
---------------- ----------------------- (Instr.5) ficially Security: Owner-
Date Expira- Amount or Owned at Direct (D) ship
Exer- tion Title Number of End of Month or Indirect (Instr.4)
cisable Date Shares (Instr. 4) (I)(Instr.4)
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</TABLE>
Explanation of Responses:
(1) The shares are held by Frontier Adjuster, Inc. Profit Sharing Plan FBO Jean
E. Ryberg. The reporting person is 100% vested in the reported shares.
/s/ Jean E. Ryberg January 10, 2000
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Jean E. Ryberg
**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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