-----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, BmvvcGH6AEyQVGgfAMhNhwOK692g7DTEgZTYUWSNwA9+6teYmgTk3n7VB3V0loBn omxKY0rvILHGIEXbzSMa8w== 0000910680-02-001023.txt : 20021217 0000910680-02-001023.hdr.sgml : 20021217 20021217164242 ACCESSION NUMBER: 0000910680-02-001023 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: KERSCHNER RICHARD D CENTRAL INDEX KEY: 0001208839 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: 02860454 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 form4rdkerschner121302.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* Kerschner Richard D. - -------------------------------------------------------------------------------- (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, General Counsel, and Secretary - -------------------------------------------------------------------------------- 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 None - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
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 $19.00 12/13/02 D(1) 50,000 (2) 11/02/10 Stock 50,000 0 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $1.42 12/13/02 A(1) 50,000 (2) 11/02/10 Stock 50,000 50,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $8.45 12/13/02 D(1) 80,000 (3) 5/29/10 Stock 80,000 0 D - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Common Stock $1.42 12/13/02 A(1) 80,000 (3) 5/29/10 Stock 80,000 80,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: (1) 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. (2) One third exercisable immediately, the remaining portion exercisable in six equal semi-annual installments beginning May 3, 2001. (3) Options to purchase 30,000 shares of common stock are exercisable on March 7, 2002, options to purchase an additional 21,429 shares of common stock are exercisable on May 30, 2002, and the remaining options to purchase 28,571 shares of common stock are exercisable on May 30, 2003. /s/ Thomas W. Haller December 16, 2002 - --------------------------------------------- ------------------- **Signature of Reporting Person Date Thomas W. Haller Attorney-in-Fact * 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 POWER OF ATTORNEY For Executing Forms 3, 4 and 5 Re: SmartServ Online, Inc. Know all by these presents, that the undersigned hereby constitutes and appoints Thomas W. Haller the undersigned's true and lawful attorney-in-fact to: (1) execute for and on behalf of the undersigned Forms 3, 4 and 5 pursuant to Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder with respect to the undersigned's securities holdings in SmartServ Online, Inc.; (2) do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete the execution of any such Form 3, 4 or 5 and the filing of such Form with the United States Securities and Exchange Commission and any other authority; and (3) take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required of, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in his discretion. The undersigned hereby grants to such attorney-in-fact full power and authority to do and perform each and every act and thing whatsoever requisite, necessary and proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do personally, with full power of substitution, hereby ratifying and confirming all that such attorney-in-fact, or his substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorney-in-fact, in serving in such capacity at the request of the undersigned, is not assuming any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended. This Power of Attorney shall remain in full force and effect until the earlier of the time (i) the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by SmartServ Online, Inc. or (ii) the foregoing attorney-in-fact receives a written revocation of this Power of Attorney. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 13th day of September, 2002. /s/ Richard D. Kerschner -------------------------- Name: Richard D. Kerschner -----END PRIVACY-ENHANCED MESSAGE-----