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FORM 5
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/ / Check box if no UNITED STATES 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 Exchange Act of 1934, Section 17(a) of the Public Utility
Instruction 1(b) Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
/ / Form 3 Holdings
Reported
/ / Form 4 Transactions
Reported
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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
Issuer (Check all applicable)
Director 10% Owner
---- ---
X Officer (give Other (Specify
---- title --- below)
Black, Paul M Cerner Corporation (CERN) below)
Chief Sales Officer & Exec VP
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(Last) (First) (Middle) 3. IRS Identification 4. Statement for 7. Individual or Joint/Group Filing
Number of Reporting Month/Year (Check applicable line)
Person, if an Entity X Form filed by One Reporting
(Voluntary) December 29, 2001 ---- Person
2800 Rockcreek Parkway Form Filed by More Than One
------------------------------------------- ------------------- ---- Reporting Person
(Street) 5. If Amendment,
Kansas City, MO 64117-2551 Date of Original
------------------------------------------- (Month/Year)
(City) (State) (Zip)
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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- 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 (D) Price (I) ship
(Instr. 4) (Instr.
4)
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Common Stock 16,144 D
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Common Stock 09/28/01 J 166 A $42.075000 166 I by Managed
(1) Account
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Common Stock 12/29/01 J 105 A (2) 433 I by Trust
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*If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). Page 1 of 3 pages (Over)
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 control number. SEC 2270 (3-99)
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 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 Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Date Expira- Amount or
--------------- Exer- tion Title Number of
(A) (D) cisable Date Shares
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Non-Qualified Stock Common
Option (right to buy) $43.290000 06/14/01 A 20,000 06/14/11 Stock 20,000
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9. Number of 10. Ownership Form 11. Nature of
Derivative of Derivative Indirect
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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20,000 D
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Explanation of Responses:
See continuation page(s) for footnotes
/s/ Paul M. Black 2-12-02
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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 is insufficient, see Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained in this form Page 2 of 3 pages Page 2
are not required to respond unless the form displays a currently valid OMB Number. SEC 2270 (3-99)
Black, Paul M Cerner Corporation (CERN)
2800 Rockcreek Parkway December 29, 2001 Page 3 of 3 pages
Kansas City, MO 64117-2551
(1) Acquired shares, not required to be reported earlier, were purchased through an Associate Stock Purchase Plan.
(2) Acquired shares held in issuer's 401(K) Trust, not required to be reported earlier, were acquired at various dates and at
various prices during the year.