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FORM 5
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/ / Check box if no U.S. SECURITIES AND EXCHANGE COMMISSION
longer subject to WASHINGTON, DC 20549
Section 16. Form
4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
obligations may
continue. See Filed pursuant to Section 16(a) of the Securities
Instruction 1(b) Exchange Act of 1934,
/ / Form 3 Holdings Section 17(a) of the Public Utility
Reported Holding Company Act of 1935 or Section 30(f) of
/ / Form 4 the Investment Company Act
Transactions of 1940
Reported
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<S> <C> <C> <C> <C> <C> <C>
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Lazzara, Jr. Gasper Orthodontic Centers of America, Inc. ("OCA") Issuer (Check all applicable)
- ------------------------------------------- ---------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
5000 Sawgrass Village Circle, Suite 25 Number of Reporting Month/Year X Officer (give Other (specify
- ------------------------------------------- Person (Voluntary) December 1999 ---- title --- below)
(Street) ------------------- below)
Ponte Vedra Beach, Florida 32082 5. If Amendment, Chairman and Co-Chief Executive
- ------------------------------------------- Date of Original Officer
(City) (State) (Zip) (Month/Year) --------------------------------
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 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. 8) End of Issuer's Direct Benefi-
(Month/ Fiscal Year (D) or cial
Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner-
Year) Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.
4)
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Common Stock 1/8/99 G 2,623 D N/A 62,688 D N/A
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80,000 I By Ponte Vedra
Long Term
Trust*
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301,832 I By charitable
trust*
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685,400 I By trusts for
benefit of
children*
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2,724,924 I By limited
partnerships*
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*If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). (Over)
SEC 2270(3-99)
Potential persons who are not 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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FORM 5 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C> <C> <C>
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Expiration Securities Deriv-
Price of (Month/ (Instr. Acquired (A) Date (Instr. 3 and 4) ative
Deriv- Day/ 8) or Disposed (Month/Day/ Secur-
ative Year) of (D) Year) ity
Security (Instr. 3, (Instr. 5)
4, and 5) -----------------------------------
Date Expira- Amount or
--------------- Exer- tion Title Number of
(A) (D) cisable Date Shares
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Option to Buy $12.375 10/26/99 A 120,000 N/A 1/1/01 12/1/09 Common 120,000 N/A
Stock
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<C> <C> <C> <C>
1. Title of Derivative 9. Number of 10. Ownership 11. Nature of
Security Derivative of Derivative Indirect
(Instr. 3) Securities Security: Beneficial
Beneficially Direct (D) Ownership
Owned at End or Indirect (I) (Instr. 4)
of Year (Instr. 4)
(Instr. 4)
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Option to Buy 872,469 D N/A
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Explanation of Responses:
* The reporting person disclaims beneficial ownership of these shares, and this report shall not be
deemed as an admission that such reporting person is the beneficial owner of such shares for purposes
of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Gasper Lazzara, Jr., D.D.S. 2/11/00
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- -------
**Signature of Reporting Person Date
Note. File three copies of this form, one of which must be manually signed. Page 2
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 number.
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