------------------------------
OMB APPROVAL
------------------------------
OMB Number: 3235-0287
Expires: January 31, 2005
Estimated average burden
hours per response.........0.5
------------------------------
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
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 of Type Responses)
- --------------------------------------------------------------------------------
1. Name and Address of Reporting Person* (2)
Wentz, Myron W.
- --------------------------------------------------------------------------------
(Last) (First) (Middle)
3838 West Parkway Blvd.
- --------------------------------------------------------------------------------
(Street)
Salt Lake City Utah 84120
- --------------------------------------------------------------------------------
(City) (State) (Zip)
- --------------------------------------------------------------------------------
2. Issuer Name and Ticker or Trading Symbol
USANA HEALTH SCIENCES, INC. (USNA)
- --------------------------------------------------------------------------------
3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary)
- --------------------------------------------------------------------------------
4. Statement for Month/Day/Year
April 28, 2003
- --------------------------------------------------------------------------------
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
________________________________________________________________________________
7. Individual or Joint/Group Filing (Check
Applicable line)
| | Form Filed by One Reporting Person
|X| Form Filed by More than One Reporting Person
- --------------------------------------------------------------------------------
================================================================================
Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
================================================================================
5.
Amount of 6.
4. Securities Owner-
Securities Acquired (A) or Beneficially ship
2A. 3. Disposed of (D) Owned Form: 7.
2. Deemed Transaction (Instr. 3, 4 and 5) Following Direct Nature of
Trans- Execution Code ------------------------------- Reported (D) or Indirect
1. action Date, if (Instr. 8) (A) Transaction(s) Indirect Beneficial
Title of Security Date any ------------ or (Instr. 3 & (I) Ownership
(Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V Amount (D) Price Instr.4) (Instr.4) (Instr.4)
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock 04/28/2003 S -35,000 D $27.60 4,751,282(1) I Shares owned
of record by
Gull Holdings
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock 04/29/2003 S -32,500 D $27.1203 4,718,782(1) I Shares owned
of record by
Gull Holdings
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock 04/30/2003 S -3,200 D $27.0434 4,715,282(1) I Shares owned
of record by
Gull Holdings
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
Page 1 of 10
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
================================================================================
9.
Number 10.
of Owner-
deriv- ship
ative Form
2. Secur- of
Conver- 5. 7. ities Deriv- 11.
sion Number of Title and Amount Bene- ative Nature
or Derivative 6. of Underlying 8. ficially Secur- of
Exer- 3A. 4. Securities Date Securities Price Owned ity: In-
cise Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Follow- Direct direct
Price 3. Execut- action or Disposed Expiration Date ---------------- Deriv- ing (D) or Bene-
1. of Trans- ion Code of(D) (Month/Day/Year) Amount ative Reported In- ficial
Title of Deriv- action Date if (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner-
Derivative ative Date any 8) 4 and 5) Date Expira- Number ity action(s) (I) ship
Security Secur- (mm/dd/ (mm/dd/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity yy) yy) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
Explanation of Responses: See attached footnote page.
/s/ Gilbert A. Fuller 04/30/03
- --------------------------------------------- -----------------------
**Signature of Reporting Person Date
By: Gilbert A. Fuller, Attorney-in-fact (3)
Wentz, Myron W.
3838 West Parkway Blvd.
Salt Lake City, UT 84120
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).
** 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 is insufficient, see Instruction 6 for procedure.
Page 2 of 10
Ownership Submission
FOOTNOTES TO FORM 4 OF MYRON WENTZ
(1) Shares owned of record by Gull Holdings Ltd., an entity owned and
controlled by this reporting person.
(2) Pursuant to Instruction 4(b)(v), this Form 4 is being filed jointly for
both Mr. Myron W. Wentz (the "designated beneficial owner") and for
Gull Holdings Ltd. Gull Holdings Ltd. is identified on the Form 4 copy
attached hereto as Amendment 1.
(3) Copy of the Power of Attorney signed by Myron W. Wentz is included as
Attachment 2.
Page 3 of 10
Attachment No. 1 to
Form 4 of Myron W. Wentz
------------------------------
OMB APPROVAL
------------------------------
OMB Number: 3235-0287
Expires: January 31, 2005
Estimated average burden
hours per response.........0.5
------------------------------
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
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 of Type Responses)
- --------------------------------------------------------------------------------
1. Name and Address of Reporting Person* (1)
Gull Holdings Ltd.
- --------------------------------------------------------------------------------
(Last) (First) (Middle)
3838 West Parkway Blvd.
- --------------------------------------------------------------------------------
(Street)
Salt Lake City Utah 84120
- --------------------------------------------------------------------------------
(City) (State) (Zip)
- --------------------------------------------------------------------------------
2. Issuer Name and Ticker or Trading Symbol
USANA HEALTH SCIENCES, INC. (USNA)
- --------------------------------------------------------------------------------
3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary)
- --------------------------------------------------------------------------------
4. Statement for Month/Day/Year
April 28, 2003
- --------------------------------------------------------------------------------
5. If Amendment, Date of Original (Month/Day/Year)
- --------------------------------------------------------------------------------
6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| | Director |X| 10% Owner
| | Officer (give title below) |_| Other (specify below)
________________________________________________________________________________
7. Individual or Joint/Group Filing (Check
Applicable line)
| | Form Filed by One Reporting Person
|X| Form Filed by More than One Reporting Person
- --------------------------------------------------------------------------------
================================================================================
Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
================================================================================
5.
Amount of 6.
4. Securities Owner-
Securities Acquired (A) or Beneficially ship
2A. 3. Disposed of (D) Owned Form: 7.
2. Deemed Transaction (Instr. 3, 4 and 5) Following Direct Nature of
Trans- Execution Code ------------------------------- Reported (D) or Indirect
1. action Date, if (Instr. 8) (A) Transaction(s) Indirect Beneficial
Title of Security Date any ------------ or (Instr. 3 & (I) Ownership
(Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V Amount (D) Price Instr.4) (Instr.4) (Instr.4)
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock 04/28/2003 S -35,000 D $27.60 4,751,282 D
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock 04/29/2003 S -32,500 D $27.1203 4,718,782 D
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock 04/30/2003 S -3,200 D $27.0434 4,715,282 D
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
Page 4 of 10
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
================================================================================
9.
Number 10.
of Owner-
deriv- ship
ative Form
2. Secur- of
Conver- 5. 7. ities Deriv- 11.
sion Number of Title and Amount Bene- ative Nature
or Derivative 6. of Underlying 8. ficially Secur- of
Exer- 3A. 4. Securities Date Securities Price Owned ity: In-
cise Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Follow- Direct direct
Price 3. Execut- action or Disposed Expiration Date ---------------- Deriv- ing (D) or Bene-
1. of Trans- ion Code of(D) (Month/Day/Year) Amount ative Reported In- ficial
Title of Deriv- action Date if (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner-
Derivative ative Date any 8) 4 and 5) Date Expira- Number ity action(s) (I) ship
Security Secur- (mm/dd/ (mm/dd/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity yy) yy) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
Explanation of Responses: See attached footnote page.
/s/ Gilbert A. Fuller 04/30/03
- --------------------------------------------- -----------------------
**Signature of Reporting Person Date
By: Gilbert A. Fuller, Attorney-in-fact(2)
Gull Holdings Ltd.
3838 West Parkway Blvd.
Salt Lake City, UT 84120
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).
** 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 is insufficient, see Instruction 6 for procedure.
Page 5 of 10
Ownership Submission
FOOTNOTES TO ATTACHMENT 1
(1) Pursuant to Instruction 4(b)(v), this document is filed as Attachment
1 to the Form 4 report of Myron W. Wentz as designated beneficial owner
for the joint filing. Gull Holdings, Ltd., the holder of record of the
shares of Common Stock disposed of, is owned and controlled by Mr.
Wentz.
(2) Copy of Power of Attorney signed by Gull Holdings Ltd. is included at
Attachment 3.
Page 6 of 10
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned hereby makes,
constitutes and appoints each of David A. Wentz and Gilbert A. Fuller each
acting individually, as the undersigned's true and lawful attorney-in-fact,
with full power and authority as hereinafter described on behalf of and in the
name, place and stead of the undersigned to:
(1) Prepare, execute, acknowledge, deliver and file Forms 3, 4, 5 and
144 (including any amendments thereto) with respect to the securities of USANA
Health Sciences, Inc., a Utah corporation (the "Company"), with the United
States Securities and Exchange Commission, any national securities exchanges and
the Company, as considered necessary or advisable under Section 16(a) of the
Securities Exchange Act of 1934 and the rules and regulations promulgated
thereunder, as amended from time to time (the "Exchange Act");
(2) Seek or obtain, as the undersigned's representative and on the
undersigned's behalf, information on transactions in the Company's securities
from any third party, including brokers, employee benefit plan administrators
and trustees, and the undersigned hereby authorizes any such person to release
any such information to the undersigned and approves and ratifies any such
release of information; and
(3) Perform any and all other acts which in the discretion of such
attorney-in-fact are necessary or desirable for and on behalf of the undersigned
in connection with the foregoing.
The undersigned acknowledges that:
(1) This Power of Attorney authorizes, but does not require, each such
attorney-in-fact to act in his or her discretion on information provided to such
attorney-in-fact without independent verification of such information;
(2) Any documents prepared and/or executed by either such
attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney
will be in such form and will contain such information and disclosure as such
attorney-in-fact, in his or her discretion, deems necessary or desirable;
(3) Neither the Company nor either of such attorneys-in-fact assumes
(i) any liability for the undersigned's responsibility to comply with the
requirement of the Exchange Act, (ii) any liability of the undersigned for any
failure to comply with such requirements, or (iii) any obligation or liability
of the undersigned for profit disgorgement under Section 16(b) of the Exchange
Act; and
(4) This Power of Attorney does not relieve the undersigned from
responsibility for compliance with the undersigned's obligations under the
Exchange Act, including without limitation the reporting requirements under
Section 16 of the Exchange Act.
The undersigned hereby gives and grants each of the foregoing
attorneys-in-fact full power and authority to do and perform all and every act
and thing whatsoever requisite, necessary or appropriate to be done in and about
the foregoing matters as fully to all intents and purposes as the undersigned
might or could do if present, hereby ratifying all that each such
Page 7 of 10
attorney-in-fact of, for and on behalf of the undersigned, shall lawfully do or
cause to be done by virtue of this Limited Power of Attorney.
This Power of Attorney shall remain in full force and effect until
revoked by the undersigned in a signed writing delivered to each such
attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney
to be executed as of this 30 day of April, 2003.
/s/ Myron W. Wentz
- ---------------------------------------------
Signature
Myron W. Wentz
- ---------------------------------------------
Print Name
STATE OF Utah )
------------------------------------
COUNTY OF Salt Lake )
-----------------------------------
On this 30 day of April, 2003 personally appeared before me, and
acknowledged that s/he executed the foregoing instrument for the purposes
therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
/s/ Betty Jean Snedeker
------------------------------------
Notary Public
My Commission Expires: June 1, 2003
------------
Page 8 of 10
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
BY THIS POWER OF ATTORNEY given on the 30th day of April 2003. GULL HOLDINGS
LIMITED a company incorporated and existing under the laws of the Isle of Man on
the 11TH April 1994, with registration number 067525C, and having its Registered
Office at Unit 1300, Summerhill Business Park, Victoria Road, Douglas, Isle of
Man (hereinafter called "the Company") hereby appoints:
Gilbert A. Fuller, acting as the undersigned's true and lawful
attorney-in-fact, with full power and authority as hereinafter described on
behalf of and in the name, place and stead of the undersigned to:
(1) Prepare, execute, acknowledge, deliver and file Forms 3, 4, 5 and
144 (including any amendments thereto) with respect to the securities of USANA
Health Sciences, Inc., a Utah corporation (the "Company"), with the United
States Securities and Exchange Commission, any national securities exchanges and
the Company, as considered necessary or advisable under Section 16(a) of the
Securities Exchange Act of 1934 and the rules and regulations promulgated there
under, as amended from time to time (the "Exchange Act");
(2) Seek or obtain, as the undersigned's representative and on the
undersigned's behalf, information on transactions in the Company's securities
from any third party, including brokers, employee benefit plan administrators
and trustees, and the undersigned hereby authorizes any such person to release
any such information to the undersigned and approves and ratifies any such
release of information; and
The undersigned acknowledges that:
(1) Any documents prepared and/or executed the attorney-in-fact on
behalf of the undersigned pursuant to this Power of Attorney will be in such
form and will contain such information and disclosure as such attorney-in-fact,
in his or her discretion, deems necessary or desirable; and will be provided to
the directors of the company.
(3) Neither the Company nor the attorney-in-fact assumes (i) any
liability for the undersigned's responsibility to comply with the requirement of
the Exchange Act, (ii) any liability of the undersigned for any failure to
comply with such requirements, or (iii) any obligation or liability of the
undersigned for profit disgorgement under Section 16(b) of the Exchange Act; and
(4) This Power of Attorney does not relieve the undersigned from
responsibility for compliance with the undersigned's obligations under the
Exchange Act, including without limitation the reporting requirements under
Section 16 of the Exchange Act.
Page 9 of 10
AND IT IS HEREBY DECLARED THAT the Company hereby authorizes and empowers the
Attorney to acknowledge in the name and as the act and deed of the Company. To
register, record this Power of Attorney in any proper office, and or registry
anywhere, throughout the world. To procure to be done any and every other act or
thing whatsoever, which may be in any way requisite or proper for authenticating
and giving full effect to the Power of Attorney according to the laws and
usage's of any country as fully and effectually as could the Company. Provided
that he the Attorney, provide copy documentation to the Directors of all actions
taken on behalf of the company.
THIS POWER OF ATTORNEY shall continue for a period of One Year from the date
hereof and shall be revocable within that time.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 30th day of April 2003.
Signature
/s/ Gavin Philip Dean
- -----------------------------------
Gavin Philip Dean
Director
/s/ Christopher Daine
- -----------------------------------
Signature
Christopher Daine
Director
On this ____ day of ______________________________ personally appeared
before me, and acknowledged that s/he executed the foregoing instrument for the
purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
--------------------------------
Notary Public
Page 10 of 10