5 1 dec2001.txt C. RAYMOND LARKIN'S FORM 5 (DECEMBER 2001) 1. Name and Address of Reporting Person Larkin, Jr., C. Raymond 21250 Hawthorne Boulevard, Suite 800 Torrance, CA 90503 USA 2. Issuer Name and Ticker or Trading Symbol DaVita Inc. (DVA) 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year 2001 5. If Amendment, Date of Original (Month/Day/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director ( ) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 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
+---------------------------------+----------+-------------+-----------------------------+----------------+-----------+------------+ |1. Title of Security |2. Trans- |3. Trans- |4. Securities Acquired (A) |5. Amount of |6. Owner- |7. Nature | | | action | action | or Disposed of (D) | Securities | ship | of In- | | | Date | Code | | Beneficially | Form: | direct | | | | | | Owned at | Direct | Bene- | | | (Month/ | | | End of | (D) or | ficial | | | Day/ | +-----------+------+----------+ Year | Indirect| Owner- | | | Year) | |Amount |A/D |Price | | (I) | ship | +---------------------------------+----------+-------------+-----------+------+----------+----------------+-----------+------------+ Common Stock 09/30/2001 A 270 A $0.0000 D Common Stock 12/31/2001 A 224 A $0.0000 494 D
TABLE II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
+-------------+--------+----------+---------+-----------+---------------------+----------------+----------+--------+-------+-------+ |1. |2. |3. |4. |5. |6. |7. |8. |9. |10. |11. | | | | | | | | | |Number |Owner- | | | | | | | | | | |of |ship | | | | | | | | | | |Deriv- |Form of| | | | | | | | |Title and Amount| |ative |Deriv- | | | | | | | | |of Underlying | |Secur- |ative |Nature | | |Conver- | | |Number of | |Securities | |ities |Secur- |of | | |sion or | | |Derivative |Date Exercisable +-------+--------+ |Benefi- |ity: |In- | | |Exercise| | |Securities |and Expiration Date | |Amount | |cially |Direct |direct | | |Price of|Transac- |Transac- |Acquired(A)|(Month/Day/Year) | |or | |Owned |(D) or |Bene- | |Title of |Deriv- |tion Date |tion Code|Disposed(D)+----------+----------+ |Number |Price of |at End |In- |ficial | |Derivative |ative |(Month/ | +-----+-----+Date Exer-|Expira- | |of |Derivative|of |direct |Owner- | |Security |Security|Day/Year) | |(A) |(D) |cisable |tion Date |Title |Shares |Security |Year |(I) |ship | +-------------+--------+----------+---------+-----+-----+----------+----------+-------+--------+----------+--------+-------+-------+ Stock Options $19.23 06/05/2001 A 18000 06/05/2002 06/05/2006 Common 18000 $0.0000 18000 D (Right to buy) Stock Explanation of Responses: Grant of Restricted Units which will vest on September 30, 2002. Grant of Restricted Units which will vest on December 31, 2002. Nonqualified stock options granted under the First Amended and Restated 1997 Equity Compensation Plan The option vests according to the following schedule: 7,334 shares on June 5, 2002, 7,333 shares on June 5, 2003 and 3,333 shares on June 5, 2004.
SIGNATURE OF REPORTING PERSON /s/ C. Raymond Larkin, Jr. DATE 02/12/2002