5 1 pmollerform5123102.txt ------ FORM 5 ------ / / Check box if no U.S. SECURITIES AND EXCHANGE COMMISSION longer subject to WASHINGTON, DC 20549 Section 16. Form 4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP obligations may continue. See Filed pursuant to Section 16(a) of the Securities Instruction 1(b) Exchange Act of 1934, / / 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 Moller, Paul Moller International, Inc. (OTC: MLER) Issuer (Check all applicable) --------------------------------------------------------------------------------------------- X Director X 10% Owner (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- --- Number of Reporting Month/Year X Officer (give Other (Specify Person (Voluntary) ---- title --- below) 9350 Currey Rd. 06 / 2002 below) ------------------------------------------- ------------------- (Street) 5. If Amendment, President Date of Original Dixon CA 95620 (Month/Year) 7. Individual or 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 4/23/2002 S4 2,000 D $ 3.25 D Common Stock 4/23/2002 S4 500 D $ 3.25 D Common Stock 5/9/2002 S4 1,000 D $ 3.25 D Common Stock 5/9/2002 S4 1,540 D $ 3.25 D Common Stock 5/9/2002 S4 2,000 D $ 3.25 D Common Stock 5/9/2002 S4 600 D $ 3.25 D Common Stock 5/9/2002 S4 308 D $ 3.25 D Common Stock 5/9/2002 S4 2,000 D $ 3.25 D Common Stock 5/9/2002 S4 500 D $ 3.25 D Common Stock 5/9/2002 S4 2,350 D $ 3.25 D Common Stock 5/9/2002 S4 1,462 D $ - D Common Stock 5/21/2002 S4 3,000 D $ 3.25 D Common Stock 5/21/2002 S4 1,538 D $ - D Common Stock 5/21/2002 S4 2,000 D $ 3.25 D Common Stock 5/21/2002 S4 2,000 D $ 3.25 D Common Stock 6/24/2002 S4 1,000 D $ 3.25 D Common Stock 6/24/2002 S4 1,000 D $ 3.25 D Common Stock 6/24/2002 S4 1,000 D $ 3.25 D Common Stock 7/1/2002 S4 1,000 D $ 3.25 D Common Stock 9/20/2002 S4 646 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 56 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 140 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 2,797 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 769 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 769 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 462 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 1,538 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 615 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 2,308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 699 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 56 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 1,231 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 4,364 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 1,399 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 769 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 7,077 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 77 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 559 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 462 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 308 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 699 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 923 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 923 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 2,769 D $ - J - Guarantee Payment Common Stock 9/20/2002 S4 154 D $ - J - Guarantee Payment ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 27,977,915 ------------------------------------------------------------------------------------------------------------------------------------
*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) (Print or Type Responses) (Bulletin No. 177, 10-15-97)
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 ------------------------------------------------------------------------------------------------------------------------------------ Common Stock Purchase Options $1.14 9/21/98 9/21/98 9/21/08 Common 6.000.000 $1.14 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
1. Title of Derivative 9. Number of 10. Ownership 11. Nature of Security Derivative of Derivative Indirect (Instr. 3) Securities Security: Beneficial Beneficially Direct (D) Ownership Owned at End or Indirect (I) (Instr. 4) of Year (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------- Common Stock 6,000,000 D Purchase Options ------------------------------------------------------------------------------------------------------- Explanation of Responses: Note 2: The Company did not recognize any compensation expense in connection with the issuance of these options, as the Company values their issuance under the "intrinsic value method", and option price exceeded or equalled the market price of the underlying stock at the time of the grant.
/s/ Paul Moller February 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). Note. File three copies of this Form, one of which must be manually signed. Page 2 If space provided is insufficient, see Instruction 6 for procedure. (Bulletin No. 177, 10-15-97)