5 1 y57429f5e5.txt FORM 5 ------ FORM 5 ------ [ ] Check box if no U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL longer subject to WASHINGTON, DC 20549 OMB Number 3235-0362 Section 16. Form Expires December 31, 2001 4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden obligations may hours per resoponse ... 1.0 continue. See Filed pursuant to Section 16(a) of the Securities Instruction 1(b) Exchange Act of 1934, [X] Form 3 Holdings Section 17(a) of the Public Utility Reported Holding Company Act of 1935 or Section 30(f) of [X] Form 4 the Investment Company Act Transactions of 1940 Reported
------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Miller, III Lloyd I. Fairmarket, Inc. FAIM Issuer (Check all applicable) --------------------------------------------------------------------------------------------- Director X 10% Owner (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- --- Number of Reporting Month/Year Officer (give Other (Specify 4550 Gordon Drive Person (Voluntary) December/2001 ---- title --- below) ------------------------------------------- ###-##-#### ------------------- below) (Street) 5. If Amendment, Date of Original Naples FL 34102 (Month/Year) 7. Individual of Joint/Group Filing ------------------------------------------- (Check Applicable Line) (City) (State) (ZIP) ------------------- x -- Form Filed by One Reoporting Person -- Form Filed by more than 1 Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature (Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In- Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct (Instr. 8) End of Issuer's Direct Benefi- (Month/ Fiscal Year (D) or cial Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner- Year) Amount (A) or Price (I) ship (D) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3(a) 20,000(1) I(a) By Lloyd I. Miller, III, Trust C ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/11/01 J(b) 683,759 683,759(b)(1) I(b) By Milgrat II(G) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3(3) 21,800(1)(3) I By Lloyd I. Miller, III, custodian under Florida UGMA for Alexandra B. Miller ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3(4) 21,900(1)(4) I By Lloyd I. Miller, III, Trustee GST f/b/o Catherine C. Miller ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3(6) 615,165(1)(6) D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 9/6/01 4(5) 7,300 A $1.01 979,375(1)(5) I By Milfam II, L.P. ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 9/7/01 4(6) 3,000 A $1.00 615,165(1)(6) D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,093,768(1)(2) I By Lloyd I. Miller, III, Trust A-4 ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 176,253(1) I By Milfam I, L.P. ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 15,400(1) I By Lloyd I. Miller, III, LLC ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 15,000(1) I By Lloyd I. Miller, III, co-trustee, Crider GST ------------------------------------------------------------------------------------------------------------------------------------ *If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)SEC 2270 (7-96) (Print or Type Responses)
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FORM 5 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price Security sion or action action Derivative cisable and of Underlying of (Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv- Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative Deriv- Day/ Disposed of (D) (Month/Day/ Secur- ative Year) (Instr. 3, 4, Year) ity Security and 5) (Instr. 5) ----------------------------------- Date Expira- Amount or --------------- Exer- tion Title Number of (A) (D) cisable Date Shares ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------- 9. Number of 10. Ownership 11. Nature of Derivative of Derivative Indirect Securities Security: Beneficial Beneficially Direct (D) Ownership Owned at End or Indirect (I) (Instr. 4) of Year (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (a) On August 31, 2001, the reporting person filed an initial Form 3 which, due to a clerical error, did not report beneficial ownership of 20,000 shares of common stock indirectly through Lloyd I. Miller, III, Trust C. These shares were subsequently transferred on December 11, 2001 to MILGRAT II (G), a grantor retained annuity trust. (b) These shares were previously reported as indirectly beneficially owned by the reporting person through Trust C, but were contributed to MILGRAT II (G), a grantor retained annuity trust of which the reporting person is Trustee, on December 11, 2001. (1) The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. This filing shall not be deemed an admission that the reporting person is, for purposes of Section 16 of the Act, or otherwise, the beneficial owner of any equity securities covered by this filing. (2) On August 31, 2001, the reporting person filed an initial Form 3 which, due to a clerical error, mistakenly reported benefcial ownership of 7,100 shares of common stock. As of December 31, 2001, the reporting person, indirectly through Trust A-4, beneficially owned 1,093,768 shares of common stock. (3) On August 31, 2001, the reporting person filed an initial Form 3 which, due to a clerical error, did not report beneficial ownership of 9,000 shares of common stock indirectly as custodian under Florida UGMA for Alexandra B. Miller. As of December 31, 2001, the reporting person, indirectly as custodian under Florida UGMA for Alexandra B. Miller, beneficially owned 21,800 shares of common stock. (4) On August 31, 2001, the reporting person filed an initial Form 3 which, due to a clerical error, did not report beneficial ownership of 9,000 shares of common stock, indirectly as Trustee GST f/b/o/ Catherine C. Miller. As of December 31, 2001, the reporting person, indirectly as Trustee GST f/b/o Catherine C. Miller, beneficially owned 21,900 shares of common stock. (5) On October 5, 2001, the reporting person filed a Form 4 which, due to a clerical error, did not report an acquisition of 7,300 shares of common stock. As of December 31, 2001, the reporting person, indirectly through Milfam II, L.P., beneficially owned 979,375 shares of common stock. (6) On August 31, 2001, the reporting person filed an initial Form 3 which, due to a clerical error, mistakenly reported direct beneficial ownership of 18,000 shares of common stock. On October 5, 2001, the reporting person filed a Form 4 which, due to a clerical error, did not report an acquisition of 3,000 shares. As of December 31, 2001, the reporting person directly beneficially owned 615,165 shares of common stock. **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Lloyd I Miller, III 2/13/02 See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- ------- **Signature of Reporting Person Date 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 3 1. Name and Address of Reporting Person: Miller, III Lloyd I. 4550 Gordon Drive Naples, Florida 34102 2. Issuer Name and Ticker or Trading Symbol: Fairmarket, Inc. - FAIM 3. Statement for Month/Year: December/2001
----------------------------------------------------------------------------------------------------------------------------------- TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature (Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In- Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct (Instr. 8) End of Issuer's Direct Benefi- (Month/ Fiscal Year (D) or cial Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner- Year) Amount (A) or Price (I) ship (D) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 9,000(1) I By Wife ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 10,500(1) I By Lloyd I. Miller, III, custodian under Florida UGMA for Tyler Dulmage ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 10,500(1) I By Lloyd I. Miller, III, custodian under Florida UGMA for Wylie Dulmage ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 15,400(1) I By Lloyd I. Miller, III, Trustee GST f/b/o Kimberly I. Miller ------------------------------------------------------------------------------------------------------------------------------------
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