-----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, AvcKZxjdla527zGSElKg1VJpwjWhOo8qP3Ew0ua252TeBhGy1biykRBoxMwXgWNp QMeAEMDwFijaAgZYt6pmEw== 0000950144-99-001965.txt : 19990217 0000950144-99-001965.hdr.sgml : 19990217 ACCESSION NUMBER: 0000950144-99-001965 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990131 FILED AS OF DATE: 19990216 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SIRROM CAPITAL CORP CENTRAL INDEX KEY: 0000933166 STANDARD INDUSTRIAL CLASSIFICATION: LOAN BROKERS [6163] IRS NUMBER: 621583116 STATE OF INCORPORATION: TN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 814-00154 FILM NUMBER: 99543466 BUSINESS ADDRESS: STREET 1: 500 CHURCH STREET STREET 2: STE 200 CITY: NASHVILLE STATE: TN ZIP: 37219 BUSINESS PHONE: 6152560701 COMPANY DATA: COMPANY CONFORMED NAME: TRAVERSI DAVID M CENTRAL INDEX KEY: 0001079436 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 500 CHURCH STREET, STE 200 CITY: NASHVILLE STATE: TN ZIP: 37219 MAIL ADDRESS: STREET 2: 500 CHURCH ST, STE 200 CITY: NASHVILLE STATE: TN ZIP: 37219 5 1 SIRROM CAPTIAL CORPORATION/ DAVID M TRAVERSI 1 - ------ 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 / / 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 Traversi David M. Sirrom Capital Corporation (SIR) Issuer (Check all applicable) - ------------------------------------------- ---------------------------------------------- Director 10% Owner (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- --- 500 Church Street, Suite 200 Number of Reporting Month/Year X Officer (give Other (specify - ------------------------------------------- Person (Voluntary) 1/99 ---- title --- below) (Street) ------------------- below) Nashville TN 37219 5. If Amendment, President - ------------------------------------------- Date of Original ------------------------------- (City) (State) (Zip) (Month/Year) 7. Individual or Joint/Group Filing ------------------ (Check applicable line) X Form Filed by one ---- Reporting Person Form Filed by more than ---- one 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) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ *If the form is filed by more than one reporting person, see instruction 4(b)(v). (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 Expiration Securities Deriv- Price of (Month/ (Instr. Acquired (A) Date (Instr. 3 and 4) ative Deriv- Day/ 8) or Disposed (Month/Day/ Secur- ative Year) of (D) Year) ity Security (Instr. 3, (Instr. 5) 4, and 5) ----------------------------------- Date Expira- Amount or --------------- Exer- tion Title Number of (A) (D) cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option $13.96875 10/1/98 D 350,000 (1) 4/3/07 Common 350,000 Stock - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option 13.96875 10/1/98 D 100,000 4/3/97 4/3/97 Common 100,000 Stock - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option 3.5625 10/1/98 A 297,500 (2) 4/3/07 Common 297,500 Stock - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option 3.5625 10/1/98 A 85,000 10/1/98 4/3/07 Common 85,000 Stock - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 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) - ------------------------------------------------------------------------------------------------------- Stock Option D - ------------------------------------------------------------------------------------------------------- Stock Option D - ------------------------------------------------------------------------------------------------------- Stock Option D - ------------------------------------------------------------------------------------------------------- Stock Option 382,500 D - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) This option fully vests April 1, 2002. (2) This option is vested as to 70,000 shares and will vest as to an additional 56,875 shares each year beginning April 1, 1999. **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ David M. Traversi 2/16/99 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. Page 2 If space provided is insufficient, see Instruction 6 for procedure. SEC 2270(3/91)
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