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Proc-Type: 2001,MIC-CLEAR
Originator-Name: webmaster@www.sec.gov
Originator-Key-Asymmetric:
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MIC-Info: RSA-MD5,RSA,
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N53TASim7KLXZqrjkDt7ZA==
FORM 5
[ ]
Check box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
OMB APPROVAL
[ ]
Form 3 Holdings Reported
[ ]
Form 4 Transactions Reported
Washington, D.C. 20549
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
OMB Number 3235-0362
Expires: January 31, 2005
Estmated average burden hours per response ... 1.0
1. Name and address of Reporting Person* |
2. Issuer Name and ticker or Trading Symbol |
6. Relationship of Reporting Person to Issuer |
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(Last)
(First) (Middle) |
3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) |
4. Statement for Month/Year 5. If Amendment, Date of Original (Month/Year) |
Director
10% Owner |
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security |
2. Transaction Date |
2A. Deemed Execution Date, if any |
3. Transaction Code |
4. Securities Acquired (A) |
5. Amount of Securities Beneficially Owned at the end of Issuer's |
6. Ownership |
7. Nature of |
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(Month/Day/Year) |
(Month/Day/Year) |
Code |
Amount |
(A) or (D) |
Price |
Fiscal Year |
Indirect (I) |
Ownership |
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Reminder: Report on a separate line for each class of securities beneficially owned
directly or indirectly
* If the form is filed by more than one reprting 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 Derivative Security |
2. Conversion or Exercise Price of Derivative Security |
3. Transaction |
3A. Deemed Execution |
4. Transaction |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) |
6. Date Exercisable and Expiration Date |
7. Title and Amount of Underlying Securities |
8. Price of Derivative Security |
9. Number of Derivative Securities Beneficially Owned at End 0f Year |
10. Ownership Form of Derivative Security. |
11. Nature of Indirect Beneficial Ownership |
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(A) |
(D) |
Date |
Expira- |
Title |
Amount or Number of Shares |
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Options to Purchase Common Stock |
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05/03/2002 |
05/03/2012 |
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10,000 |
* $ 2.64 |
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D |
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Explanation of Responses:
* Options are granted at the market price as of 5/3/02 at $2.64 per share and
are exercisable over the next ten years at the rate of 25% per year from date
of issue.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. |
/s/
Mike Schmidt
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February 13, 2003
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© H.J. Meyer Consulting October 31, 2002
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