5 1 ebf5.htm BODY Form 5
FORM 5 
  

|_| Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). 

|_| Form 3 Holdings Reported 

|_| Form 4 Transactions Reported

UNITED STATES SECURITIES AND EXCHANGE COMMISSION 
Washington, DC 20549 
 

ANNUAL STATEMENT OF CHANGES 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

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1.  Name and Address of Reporting Person* 
 
2.  Issuer Name and Ticker or Trading Symbol 

SUMmedia.com, Inc. 
ISUM

6.  Relationship of Reporting Person(s) to Issuer 
                       (Check all applicable) 

___Director         ___ 10% owner 

_X_Officer (give title below):  

___Chief Financial Officer_____ 

___ Other (specify below) 
 
 

(Last)(First)(Middle) 

Baergen, L. Evan

3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) 
 
4. Statement for Month/Year 

December 2001 
 

(Street) 

Suite #310 
750 Terminal Ave.

5.  If Amendment, Date of Original (Month/Year) 
 
7.  Individual or Joint/Group Reporting 
         (check applicable line) 

__X_ Form Filed by One Reporting Person 

____ Form Filed by More than One Reporting Person 
 

(City) (State) (Zip) 
Vancouver, BC 
V6A 2M5 
CANADA
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.  Title of Security 
(Instr. 3) 
 
2.  Trans-action Date (Month/ Day/ Year) 
 
3.  Trans-action 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.  Owner-ship Form: Direct (D) or Indirect (I) 
(Instr. 4) 
 
7.  Nature of Indirect Beneficial Ownership 
(Instr. 4) 
 
Amount (A) or (D) Price
Nil

 
 
 
 

* 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 Derivative Security 
(Instr. 3) 
 
2.  Conver- sion or Exercise Price of Derivative Security 
 
3.  Trans- action Date (Month/ Day/ Year) 
 
4.  Trans- action Code 
(Instr. 8) 
 
5.  Number of Derivative Securities Acquired (A) or Disposed of (D)  
(Instr. 3, 4 and 5) 
 
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) 
 
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to buy) $3.125 01/10/00 (A) 75,000   Common Stock N/A 75,000 (D) N/A
Explanation of Responses:
_______L. Evan Baergen______________ 
**Signature of Reporting Person
_________February 11, 2002__________ 
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.
http://www.sec.gov/divisions/corpfin/forms/form5.htm
Last update: 02/11/2002