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OMB APPROVAL
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OMB Number 3235-0167
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 15
CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER SECTION 12(g) OF
THE SECURITIES EXCHANGE ACT OF 1934 OR SUSPENSION OF DUTY TO FILE REPORTS UNDER
SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.
Commission File Number 0-21098
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Physicians Health Services, Inc.
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(Exact name of registrant as specified in the charter)
One Far Mill Crossing, Shelton, Connecticut 06484-0944 (203) 381-6400
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(Address, including zip code and telephone number, including area code, of
registrant's principal executive offices)
Class A Common Stock, Class B Common Stock
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(Title of each class of securities covered by this Form)
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(Titles of all other classes of securities for which a duty to file reports
under section 13(a) or 15(d) remains)
Please place an X in the box(es) to designate the appropriate rule provision(s)
relied upon to terminate or suspend the duty to file reports:
Rule 12g-4(a)(1)(i) [x] Rule 12h-3(b)(1)(i) [x]
Rule 12g-4(a)(1)(ii) [ ] Rule 12h-3(b)(1)(ii) [ ]
Rule 12g-4(a)(2)(i) [ ] Rule 12h-3(b)(2)(i) [ ]
Rule 12g-4(a)(2)(ii) [ ] Rule 12h-3(b)(2)(ii) [ ]
Rule 15d-6 [ ]
Approximate number of holders of record as of the certification or
notice date: 1
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Pursuant to the requirements of the Securities Exchange Act of 1934
Physicians Health Services, Inc. has caused this certification/notice to be
signed on its behalf by the undersigned duly authorized person.
Date: January 20, 1998 By: /s/ Robert L. Natt
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Name: Robert L. Natt
Title: President and Co-Chief
Executive Officer
Instruction: This form is required by Rule 12g-4, 12h-3 and 15d-6 of the General
Rules and Regulations under the Securities Exchange Act of 1934. The registrant
shall file with the Commission three copies of Form 15, one of which shall be
manually signed. It may be signed by an officer of the registrant, by counsel or
by any other duly authorized person. The name and title of the person signing
the form shall be typed or printed under the signature.
