-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, AMXG3XN5kF3Lph3oa7ylpvOz36CniF1h8dzKSLBiPP3HkaZCJIoGJM2aniTDOuEv 3XaVt+iCou+d9zw/QaIcXw== 0000910680-02-001021.txt : 20021217 0000910680-02-001021.hdr.sgml : 20021217 20021217164150 ACCESSION NUMBER: 0000910680-02-001021 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021213 FILED AS OF DATE: 20021217 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: HALLER THOMAS W CENTRAL INDEX KEY: 0001208835 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O SMARTSERV ONLINE INC STREET 2: METRO CENTER ONE STATION PLACE CITY: STAMFORD STATE: CT ZIP: 06902 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SMARTSERV ONLINE INC CENTRAL INDEX KEY: 0001005698 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 133750708 STATE OF INCORPORATION: DE FISCAL YEAR END: 0902 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-28008 FILM NUMBER: 02860451 BUSINESS ADDRESS: STREET 1: METRO CENTER STREET 2: ONE STATION PLACE CITY: STAMFORD STATE: CT ZIP: 06902 BUSINESS PHONE: 2033535950 MAIL ADDRESS: STREET 1: ONE STATION PLACE CITY: STAMFORD STATE: CT ZIP: 06902 4 1 form4twhaller121302.txt DECEMBER 13, 2002 ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response ....... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 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(f) of the Investment Company Act of 1940 [ ] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Haller Thomas W. - -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o SmartServ Online, Inc. Metro Center, One Station Place - -------------------------------------------------------------------------------- (Street) Stamford CT 06902 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol SmartServ Online, Inc. (SSOL) - -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Day/Year December 13, 2002 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) Senior Vice President, Treasurer and Chief Financial and Accounting Officer - -------------------------------------------------------------------------------- 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 ================================================================================
6. 4. 5. Owner- 2A. Securities Acquired (A) or Amount of ship Deemed 3. Disposed of (D) Securities Form: 7. Execution Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Date, if Code -------------------------- Owned at End (D) or Indirect 1. Transaction any (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date (mm/dd/yy) ----------- Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.01 per share 666 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Page 1 of 2 (Over) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. 6. Deriv- of Conver- 5. Date 7. ative Deriv- 11. sion Number of Exercisable Title and Amount Secur- ative Nature or Derivative and of Underlying 8. ities Secur- of Exer- 4. Securities Expiration Date Securities Price Bene- ity: In- cise 3. 3A. Trans- Acquired (A) (Month/Day/Year) (Instr. 3 and 4) of ficially Direct direct Price Trans- Deemed action or Disposed ---------------- ---------------- Deriv- Owned (D) or Bene- 1. of action Execution Code of(D) Amount ative at End In- ficial Title of Deriv- Date Date, if (Instr. (Instr. 3, or Secur- of direct Owner- Derivative ative (Month/ any 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ (Month/Day ------ ----------- Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $1.29 (1) 10/07/08 Stock 15,000 15,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $1.625 (2) 11/20/08 Stock 17,000 17,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $10.50 3/21/96 3/20/03 Stock 400 1,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $0.9375 12/13/02 (3) 10/12/09 Stock 72,000 72,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $49.50 12/13/02 D(4) 7,000 (5) 5/29/10 Stock 7,000 0 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $1.42 12/13/02 A(4) 7,000 (5) 5/29/10 Stock 7,000 7,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $19.00 12/13/02 D(4) 50,000 (6) 11/02/10 Stock 50,000 0 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $1.42 12/13/02 A(4) 50,000 (6) 11/02/10 Stock 50,000 50,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $8.20 12/13/02 D(4) 22,500 (7) 12/6/11 Stock 22,500 0 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $1.42 12/13/02 A(4) 22,500 (7) 12/6/11 Stock 22,500 22,500 D ====================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: (1) Exercisable in two equal annual installments, beginning October 8, 1999. (2) Exercisable in two equal annual installments, beginning November 20, 1999. (3) Exercisable in two equal annual installments, beginning October 11, 2000. (4) The reported transaction involved the repricing of an existing option that was approved by the Stockholders of SmartServ at the Annual Meeting of Stockholders on December 13, 2002. (5) Exercisable in two equal annual installments, beginning May 30, 2001. (6) One third exercisable immediately, the remaining portion exercisable in six equal semi-annual installments beginning May 3, 2001. (7) Exercisable as to 30% on December 7, 2002, 30% on December 7, 2003 and 40% on December 7, 2004. /s/ Thomas W. Haller December 16, 2002 - --------------------------------------------- ------------------- **Signature of Reporting Person Date Thomas W. Haller * 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 provided is insufficient, see Instruction 6 for procedure. Page 2 of 2 -----END PRIVACY-ENHANCED MESSAGE-----