-----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, VYLLjuLjqH5jcIBS4DXuQemB7JJ541lV2jEIdoGjczFkvsPb3ahmMhEfzLRkMaDH k4MiBfowWjvYqFFPpHl19g== 0001036262-02-000002.txt : 20020414 0001036262-02-000002.hdr.sgml : 20020414 ACCESSION NUMBER: 0001036262-02-000002 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20011231 FILED AS OF DATE: 20020214 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTEST CORP CENTRAL INDEX KEY: 0001036262 STANDARD INDUSTRIAL CLASSIFICATION: INSTRUMENTS FOR MEAS & TESTING OF ELECTRICITY & ELEC SIGNALS [3825] IRS NUMBER: 222370659 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22529 FILM NUMBER: 02544490 BUSINESS ADDRESS: STREET 1: 2 PIN OAK LANE CITY: CHERRY HILL STATE: NJ ZIP: 08003 BUSINESS PHONE: 6094246886 COMPANY DATA: COMPANY CONFORMED NAME: GRAHAM DANIEL J CENTRAL INDEX KEY: 0001051995 OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: C/O INTEST CORP STREET 2: 2 PIN OAK LANE CITY: CHERRY HILL STATE: NJ ZIP: 08003 BUSINESS PHONE: 6094246886 MAIL ADDRESS: STREET 1: C/O INTEST CORP STREET 2: 2 PIN OAK LANE CITY: CHERRY HILL STATE: NJ ZIP: 08003 5 1 form5-djg01.txt
- ------------ U.S. SECURITIES AND EXCHANGE COMMISSION --------------------------- |F O R M 5 | Washington, D.C. 20549 | OMB APPROVAL | - ------------ --------------------------- ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |OMB Number 3235-0362| [ ] Check this box if |Expires: PENDING | no longer subject Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, | Estimated average burden | to Section 16. Section 17(a) of the Public Utility Holding Company Act of 1935 or | hours per response....1.0 | [ ] Form 3 Holdings Reported Section 30(f) of the Investment Company Act of 1940 --------------------------- [ ] Form 4 Holdings Reported - ----------------------------------------------------------------------------------------------------------------------------------- |1. Name & Address of Reporting Person |2.Issuer Name & Ticker or Trading Symbol |6. Relationship of Reporting Person to Issuer| | | | (Check all Applicable) | | Graham Daniel J. | inTEST Corporation (INTT) | | | | | X Director 10% Owner | |---------------------------------------|-------------------------------------------| --- --- | | (Last) (First) (MI) |3.IRS or Soc. Sec. No.|4. Statement for | X Officer Other | | | of Reporting Person | Month/Year | --- (Give title below) --- (Specify below)| | c/o inTEST Corporation | (Voluntary) | | | | 7 Esterbrook Lane | | December 31, 2001 | Sr. Vice President | |---------------------------------------| |--------------------|---------------------------------------------| | (Street) | |5. If Amendment, |7. Individual or Joint/Group Filing | | | | Date of | (Check Applicable Line) | | | | Original | | | | | (Month/Year) | X Form filed by One Reporting Person | | | | | --- | | | | | Form filed by More than One Reporting | | Cherry Hill NJ 08003 | | | --- Person | |---------------------------------------|----------------------|--------------------|---------------------------------------------| | (City) (State) (Zip) | | Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |---------------------------------------------------------------------------------------------------------------------------------| |1.Title of Security |2.Transaction |3.Transaction|4.Securities Acquired (A) |5.Amount of |6.Ownership |7. Nature of Indirect | | (Instr. 3) | Date (M/D/Y)| Code | or Disposed of (D) | Securities | Form: | Beneficial | | | | (Instr. 8) | (Inst. 3, 4 and 5) | Beneficially | Direct (D)| Ownership | | | |-------------|--------------------------| Owned at End | or In- | (Instr. 4) | | | | | |(A)| | of Issuer's | direct(I) | | | | | Code | Amount |(D)| Price | Fiscal Year | (Instr. 4)| | |---------------------|--------------|-------------|------------|---|---------|--------------|------------|-----------------------| | | | | || | | | | |Common Stock | 6/21/01 | G | 1,500 | D | | | | | |---------------------|--------------|-------------|------------|---|---------|--------------|------------|-----------------------| |Common Stock | 6/21/01 | G | 1,500 | D | | | | | |---------------------|--------------|-------------|------------|---|---------|--------------|------------|-----------------------| |Common Stock | 6/21/01 | G | 1,500 | D | | | | | |---------------------|--------------|-------------|------------|---|---------|--------------|------------|-----------------------| |Common Stock | 6/21/01 | G(1) | 1,500 | D | | | | | |---------------------|--------------|-------------|------------|---|---------|--------------|------------|-----------------------| |Common Stock | 6/21/00 | G(1) | 15,000 | D | | 276,260 | D | | |---------------------|--------------|-------------|------------|---|---------|--------------|------------|-----------------------| |Common Stock | 11/14/00 | G(1) | 1,500 | A | | 6,800 | I(2) | By Child | |---------------------|--------------|-------------|------------|---|---------|--------------|------------|-----------------------| |Common Stock | 11/14/00 | G(1) | 15,000 | A | | 56,000 | I(2) | By Spouse | |---------------------|--------------|-------------|------------|---|---------|--------------|------------|-----------------------| | | | | | | | | | | |---------------------|--------------|-------------|------------|---|---------|--------------|------------|-----------------------| PAGE 1 OF 2
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) - ----------------------------------------------------------------------------------------------------------------------------------- |1.Title of |2.Conver- |3.Trans-|4.Trans-|5.Number of|6.Date Exer-|7.Title & Amount |8.Price of |9.Number of |10.Owner-|11.Nature| | Derivative| sion or | action | action| Derivative| cisable and| of Underlying | Derivative| Derivative | ship | of In- | | Security | Exercise | Date | Code | Securities| Expiration | Securities | Security | Securities | Form of| direct | | (Instr. 3)| Price of | (M/D/Y)|(Inst.8)| Acquired | Date(M/D/Y)| (Instr. 3 and 4)| (Instr. 5)|Beneficially| Deriva- | Benefi-| | |Derivative| | |(A) or Dis-|------------|-----------------| | Owned at | tive | cial | | |Security | | |posed of(D)|Date | | | | | End of | Security| Owner- | | | | |--------|-----------|Exer-|Expir-| | Amount or | | Year | Direct | ship | | | | | | | |cisa-|ation | | Number of | | (Instr. 4) | (D) or |(Instr 4)| | | | | Code | (A) | (D) | ble | Date |Title| Shares | | |(Instr.4)| | |------------|----------|--------|--------|-----|-----|-----|------|-----|-----------|-----------|------------|---------|---------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |------------|----------|--------|--------|-----|-----|-----|------|-----|-----------|-----------|------------|---------|---------| | | | | | | | | | | | | | | | |------------|----------|--------|--------|-----|-----|-----|------|-----|-----------|-----------|------------|---------|---------| | | | | | | | | | | | | | | | |------------|----------|--------|--------|-----|-----|-----|------|-----|-----------|-----------|------------|---------|---------| | | | | | | | | | | | | | | | |------------|----------|--------|--------|-----|-----|-----|------|-----|-----------|-----------|------------|---------|---------|
Explanation of Responses: (1) Gift to family member who shares reporting person=s household. (2) The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed to be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. /s/Daniel J. Graham 2/14/2002 - ------------------------------------------ -------------- **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). PAGE 2 OF 2 -----END PRIVACY-ENHANCED MESSAGE-----