-----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, AdJRZ1INHr9ikUVdCpUDJ4DeHQkcCYSlQ91rYjwjnOSVBppGX+vwGNcrj/v9PmJF 3nYrvmpfuEBANfT4Gt4gCA== 0000950134-03-001803.txt : 20030207 0000950134-03-001803.hdr.sgml : 20030207 20030207100053 ACCESSION NUMBER: 0000950134-03-001803 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020228 FILED AS OF DATE: 20030207 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: SHAW JERRY CENTRAL INDEX KEY: 0001184551 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: C/O INSITUFORM TECHOLOGIES INC STREET 2: 702 SPIRIT 40 PARK DRIVE CITY: CHESTERFIELD STATE: MO ZIP: 63005 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INSITUFORM TECHNOLOGIES INC CENTRAL INDEX KEY: 0000353020 STANDARD INDUSTRIAL CLASSIFICATION: WATER, SEWER, PIPELINE, COMM AND POWER LINE CONSTRUCTION [1623] IRS NUMBER: 133032158 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10786 FILM NUMBER: 03543565 BUSINESS ADDRESS: STREET 1: 702 SPIRIT 40 PARK DRIVE CITY: CHESTERFIELD STATE: MO ZIP: 63005 BUSINESS PHONE: 6365308000 MAIL ADDRESS: STREET 1: 702 SPIRIT 40 PARK DRIVE CITY: CHESTERFIELD STATE: MO ZIP: 63005 FORMER COMPANY: FORMER CONFORMED NAME: INSITUFORM OF NORTH AMERICA INC DATE OF NAME CHANGE: 19921217 FORMER COMPANY: FORMER CONFORMED NAME: INSITUFORM OF NORTH AMERICA INC/TN/ DATE OF NAME CHANGE: 19930617 5 1 c74563ae5.htm FORM 5 Insituform Technologies, Inc.
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

FORM 5

ANNUAL 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(h) of the Investment Company Act of 1940

o Check box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
o Form 3 Holdings Reported
x Form 4 Transactions Reported

1. Name and Address of Reporting
Person*
2. Issuer Name and Ticker or Trading
Symbol
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Shaw, Jerry
(Last) (First) (Middle)
  Insituform Technologies, Inc. (INSU)
 
   
                 
  705 McBride Pointe
4. Statement for Month/Year 5. If Amendment, Date of Original (Month/Year)
    February 2002
 
  (Street) 6. Relationship of Reporting Person(s)
to Issuer
(Check All Applicable)
7. Individual or Joint/Group Reporting
(Check Applicable Line)
  Wildwood, MO 63011
(City)        (State)        (Zip)
  o  Director o  10% Owner   x Form filed by One Reporting Person
    x  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)  
      Vice President-Tunneling (Affholder, Inc., a wholly-owned subsidiary of the issuer)
     

*   If the form is filed by more than one reporting person, see instruction 4(b)(v).


 

                                                 

Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of
Security

(Instr. 3)
2. Transaction
Date

(Month/Day/Year)
2A. Deemed Execution
Date, if any

(Month/Day/Year)
3. Transaction
Code

(Instr. 8)
4. Securities Acquired (A)
or Disposed of (D)

(Instr. 3, 4 and 5)
5. Amount of Securities
Beneficially Owned
at the End of Issuer's
Fiscal Year

(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)

(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

                    Amount (A)
or
(D)
Price            

  None                    

                     

                     

                     

                     

                     

                     

Page 2


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative
Security

(Instr. 3)
2. Conversion or Exercise
Price of Derivative
Security
3. Transaction Date
(Month/Day/Year)
3A. Deemed Execution
Date, if any

(Month/Day/Year)
4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)

(Instr. 3, 4 and 5)

                            (A) (D)

  Stock Option (right to buy)     $23.92     2/25/02     A(1)   8,053 - --

  Stock Option (right to buy)     $23.92     2/25/02     A(2)   748 - --

               

               

               

               

               

               

               

Page 3


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date

(Month/Day/Year)
7. Title and Amount of
Underlying Securities

(Instr. 3 and 4)
8. Price of Derivative
Security

(Instr. 5)
9. Number of Derivative
Securities Beneficially
Owned at End of
Year

(Instr. 4)
10. Ownership of
Derivative Security:
Direct (D)
or Indirect (I)

(Instr. 4)
11. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

  Date
Exercisable
Expiration
Date
  Title Amount or
Number of
Shares
                       

  2/25/02(1) 2/25/12   Class A common shares, $.01 par value 8,053     See column 2       32,453     D   - --

  2/25/02(2) 2/25/12   Class A common shares, $.01 par value 748     See column 2       1,898     I   By spouse

                   

                   

                   

                   

                   

                   

                   

Explanation of Responses:

(1) Grant to the undersigned of option to buy 8,053 shares of common stock under the issuer's 2001 Employee Equity Incentive Plan, 2,013 of which are exercisable on February 25, 2002 (date of grant), 2003 and 2004, respectively, and 2,014 of which are exercisable on February 25, 2005.

(2) Grant to the undersigned's spouse of option to buy 748 shares of common stock under the issuer's 2001 Employee Equity Incentive Plan, 187 of which are exercisable on February 25, 2002 (date of grant) and each anniversary thereof through February 25, 2005, respectively.

/s/ Jerry Shaw   February 6, 2003

**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.

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