HAVENS PETER H 4

4 · NOBEL LEARNING COMMUNITIES INC · Filed Jan 11, 2005

Form 4

Period: 2004-12-30

Director

Transactions

Conversion
Common Stock
[F1]
2004-12-30+3,234→ 3,234 total
Conversion
Common Stock
[F1][F2]
2004-12-30+1,176→ 1,176 total(indirect: See Footnote 2)
Conversion
Common Stock
[F1][F3]
2004-12-30+1,470→ 1,470 total(indirect: See Footnote 3)
Conversion
Series A Convertible Preferred Stock
[F4][F5]
2004-12-30−11,000→ 0 total
From: 1993-05-28→ Common Stock (3,234 underlying)
Conversion
Series A Convertible Preferred Stock
[F4][F5][F2]
2004-12-30−4,000→ 0 total(indirect: See Footnote 2)
From: 1993-05-28→ Common Stock (1,176 underlying)
Conversion
Series A Convertible Preferred Stock
[F4][F5][F3]
2004-12-30−5,000→ 0 total(indirect: See Footnote 3)
From: 1993-05-28→ Common Stock (1,470 underlying)

Footnotes (5)

[F1]Conversion of Series A Convertible Preferred Stock at a conversion rate of 0.2940 share of Common Stock for each share of Series A Convertible Preferred Stock.
[F2]Held by J.P. Havens TFBO his son over which the Reporting Person has sole voting and dispositive authority and as to which the Reporting Person disclaims beneficial ownership.
[F3]Held by Mary L. Smith TFBO Victoria L. Havens, the Reporting Person's daughter, over which the Reporting Person has sole voting and dispositive authority and as to which the Reporting Person disclaims beneficial ownership.
[F4]Convertible into Common Stock at a conversion rate of 0.2940 share of Common Stock for each share of Series A Convertible Preferred Stock.
[F5]N/A

Signature

Peter H. Havens|2005-01-11

Documents

1 file