4: Statement of changes in beneficial ownership of securities
Published on January 3, 2003
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
OMB APPROVAL
----------------------------
OMB Number: 3235-0287
Expires: January 31, 2005
Estimated average burden
hours per response.......0.5
FORM 4
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(h) of the Investment Company Act of 1940
[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
(Print or Type Responses)
- --------------------------------------------------------------------------------
1. Name and Address of Reporting Person*
Rollins, Gary W.
- --------------------------------------------------------------------------------
(Last) (First) (Middle)
2170 Piedmont Road NE
- --------------------------------------------------------------------------------
(Street)
Atlanta, GA 30324
- --------------------------------------------------------------------------------
(City) (State) (Zip)
- --------------------------------------------------------------------------------
2. Issuer Name and Ticker or Trading Symbol
Rollins, Inc. (ROL)
- --------------------------------------------------------------------------------
3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)
- --------------------------------------------------------------------------------
4. Statement for Month/Day/Year
12/31/02
- --------------------------------------------------------------------------------
5. If Amendment, Date of Original (Month/Day/Year)
- --------------------------------------------------------------------------------
6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[X] Director [X] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
CEO, President, & Chief Operating Officer
- --------------------------------------------------------------------------------
7. Individual or Joint/Group Filing (Check Applicable Line)
[X] Form filed by One Reporting Person
[ ] Form filed by More than One Reporting Person
- --------------------------------------------------------------------------------
================================================================================
Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
================================================================================
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction
4(b)(v).
** This number includes 13,512 shares of 401(k) stock first reported in January
2002.
J(a) - See Exhibit A Attached (Over)
SEC 1474 (9/02)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
================================================================================
Explanation of Responses:
/s/ Gary W. Rollins
Signed by Glen P. Grove, Jr.
As Power of Attorney January 3, 2002
- ------------------------------- -----------------------
**Signature of Reporting Person Date
*Gary W. Rollins disclaims for the purpose of Section 16 of the Securities and
Exchange Act of 1934, the beneficial ownership of the shares described in Table
1, lines 2-10, and this report is not an admission of such beneficial
ownership.
** 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 required to respond unless the form displays a currently
valid OMB Number.
Page 2
Exhibit A
Gary W. Rollins
(a) The Reporting Person beneficially and indirectly owns a portion of the
Rollins, Inc. (ROL) shares owned by the following entities:
LOR, Inc. a Georgia corporation
Rollins Holding Company, Inc., a Georgia corporation
The Reporting Person reports indirect holdings of ROL shares as
Trustee, co-Trustee or Manager of the following entities but has no
pecuniary interest in these shares:
MRLT Partners, L.P., a Georgia limited partnership
RCTLOR, LLC, a Georgia limited liability company, through LOR, Inc.,
its Manager RRR Grandchildren's Custodial Partnership I, L.P., a
Georgia limited partnership 1997 RRR Grandchildren's Partnership, a
Georgia general partnership
All shares owned by the above entities were contributed to RFPS
Investments I, L.P. (RFPS), a Georgia limited partnership, along with
ROL shares contributed by the following entities and persons on
formation of RFPS:
Grace C. Rollins, individually
Pamela R. Rollins, individually
Timothy C. Rollins, individually
Amy Rollins Kreisler, individually
Nancy Rollins Griffith, individually
1976 Gary W. Rollins Grandchildren's Trust as co-Trustee
1996 JR Partnership, L.P., a Georgia limited partnership
1996 JPR Partnership, L.P., a Georgia limited partnership
2001 RRR, Jr. Grantor Trust, as Trustee
RWR Management Company, LLC, a Georgia limited liability company, as
Manager and Trustee of its sole Member
The general partner of RFPS is LOR Investment Company, LLC, a Georgia
limited liability company, wholly owned by LOR, Inc. The Reporting
Person is an officer, director and shareholder of LOR, Inc. As a result
of the contribution to RFPS, the Reporting Person now reports an
indirect interest in all of the ROL shares held by RFPS.
The Reporting Person disclaims ownership of these shares in excess of
his pecuniary interest.