5 1 kl02039_form5.txt FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |_| 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 1. Name and Address of Reporting Person Rossettos, Nicholas J. c/o Atlantic Technology Ventures, Inc. 350 Fifth Avenue, Suite 5507 New York, NY 10118 2. Issuer Name and Ticker or Trading Symbol Atlantic Technology Ventures, Inc. ("ATLC.OB") 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year December 2001 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Secretary, Treasurer and Chief Financial Officer 7. Individual or Joint/Group Reporting (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. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | |Transaction| or Disposed of (D) | Securities |ect | Beneficial Ownership | |Date |Code| (Instr.3,4 and 5) | Beneficially |(D)or | (Instr. 4) | | |(Ins| | A/| | Owned at |Indir | | | |tr.8) Amount | D | Price | End of Year |ect(I)| | | | | | | (Instr. 3 and 4) |(Ins | | | | | | | | tr.4)| | -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. *If form is filed by more than one reporting person, see instruction 4(b)(v). (Over) SEC 2270(7-96) FORM 5 (continued) Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
----------------------------------------------------------------------------------------------------------------------------------- Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned | -----------------------------------------------------------------------------------------------------------------------------------| 1.Title of Derivative |2.Con |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of| Security |version |Transaction rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect | |or Exer |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise Pr | |(In | red(A) or Dis |Date(Month/| (Instr. 3 and 4 |Secu |Securities |(D)|Ownership | |ice of | |str.| posed of(D) |Day/Year) | |rity |Benefi |or | | |Deriva | | 8) | (Instr.3,4 and|Date |Expir| |(Instr.|ficially |Ind| | |tive | | | 5) | |Exer-|ation| Title and Number | 5) |Owned at |ire| | |Secu | | | | |cisa-|Date | of Shares | |End of |ct | | |rity | | | A | D |ble | | | |Year |(I)| | | | | | | | | | | |(Instr. 4) |(Instr. 4) | -----------------------------------------------------------------------------------------------------------------------------------| Option (Right to buy) | 0.875 |2/20/| A | 50,000 | | (1) |2/20/|Common Stock|50,000 | |100,000 | D | | | |01 | | | | |11 | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------|
Explanation of Responses: (1) The option becomes exercisable in four equal annual installments upon optionee's completion of each successive year of service beginning on each of the first, second, third and fourth anniversaries of the grant date specified in Column 3. /s/ Nicholas J. Rossettos February 14, 2002 ------------------------------- --------------- **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. 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 Number. Page 2 of 2