OMB APPROVAL
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OMB Number 3235-0362
-------- Expires: January 31, 2005
FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION Estimated average burden
-------- Washington, D.C. 20549 hours per response.. 1.0
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[ ] Check box if no longer
subject to Section 16.
Form 4 or Form 5 obligations
may continue.
See Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
ANNUAL 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
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1. Name and Address of Reporting Person*
Chernow David S.
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(Last) (First) (Middle)
4324 East Orchard Lane
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(Street)
Littleton CO 80121
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Select Medical Corporation - NYSE (SEM)
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3. IRS Identification Number of Reporting
Person, if an Entity (Voluntary)
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4. Statement for Month/Year
December 31, 2002
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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 Other (specify below)
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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Table I - Non-Derivative Securities, Acquired, Disposed of,
or Beneficially Owned
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1. Title of Security 2. Trans- 2A. 3.Transaction 4. Securities 5. Amount of 6. Ownership Form: 7.Nature of
(Instr. 3) action Deemed Code Acquired (A) Securities Direct (D) or Indirect
Date Execution (Instr. 8) or Disposed of Beneficially Indirect (I) Beneficial
(Month/ Date, if (D) (Instr. 3, Owned at the (Instr. 4) Ownership
Day/ any 4 and 5) end of Issuer's (Instr. 4)
Year) (Month/ Fiscal Year
Day/ (Instr. 3 and 4)
Year)
Amount (A)or Price
(D)
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* If the form is filed by more than one reporting person, see instruction
4(b)(v).
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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)
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1.Title of 2.Conver- 3.Trans- 3A. 4.Transac- 5.Number 6.Date 7.Title 8.Price 9.Number 10. Owner- 11.Nature
Derivative sion or action Deemed tion of Exer- and of of ship of
Security Exercise Date Execu- Code Deriv- cisable Amount Deriv- Deriv- of De- Indir-
(Instr. 3) Price of (Month/ tion (Instr. ative and Ex- of ative ative riva- ect
Deriv- Day/ Date, if 8) Secur- pira- Under- Secur- Secur- tive Bene-
ative Year) any ities tion lying ity ities Secu- ficial
Security (Month/ Ac- Date Secur- (Instr. Bene- rity: Owner-
Day/Year) quired (Month/ ities 5) ficially Direct ship
(A) or Day/ (Instr. Owned at (D) or (Instr.
Disposed Year) 3 and 4) End of Indirect 4)
of (D) Year (I)
(Instr. (Instr. 4) (Instr. 4)
3, 4 and
5)
(A) (D) Date Ex- Title Amount
Ex- pir- or
ercis- ation Number
able Date of
Shares
Non-qualified $14.04 2/12/02 A 7,000 (1) 2/11/12 Com- 7,000 7,000 (D)
Stock Options mon
(right to buy) Stock
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Explanation of Responses:
(1) The original option grant of 7,000 options vests over 5 years in equal
parts of 1/5th of the total per year, beginning on 2/12/03.
/s/ David S. Chernow 1/31/03
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** 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 provided is insufficient, see Instruction 6 for procedure.
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