3 1 v80249e3.htm AMBASSADORS INTERNATIONAL, INC. FORM 3 AMBASSADORS INTERNATIONAL, INC. FORM 3
 

       

 
FORM 3  
OMB APPROVAL

 
    OMB NUMBER: 3235-0104
    Expires: September 30, 1998
    Estimated average burden  
    hours per response 0.5
   

U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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

(Print or Type Responses)
             

1.   Name and Address of Reporting Person* 3.   IRS or Social Security Number of Reporting Person (Voluntary) 6.   If Amendment, Date of Original (Month/Day/Year)
Fogarty, Timothy T.        



(Last)
(First)
(Middle)
      4.   Issuer Name and Ticker or Trading Symbol 7.   Individual or Joint/Group Filing (Check Applicable Line)
1071 Camelback Street   Ambassadors International, Inc. AMIE   [X] Form filed by One Reporting Person

 
  [ ] Form filed by More than One Reporting Person
(Street)
       
        5.   Relationship of Reporting Person(s) to Issuer
(Check all applicable)
   
Newport Beach, CA 92660    

[ ] Director [   ] 10% Owner  
(City)
(State)
(Zip)
  [X] Officer (give title below)    
[ ] Other (specify below)
2. Date of Event Requiring Statement (Month/Day/Year)  
3/1/02 Chief Financial Officer, Treasurer and Secretary



 


TABLE I — Non-Derivative Securities Beneficially Owned

             
1.   Title of Security (Instr. 4)
 
2.   Amount of Securities Beneficially Owned (Instr. 4)
 
3.     Ownership Form: Direct (D) or Indirect (I) (Instr. 5)
 
4.    Nature of Indirect Beneficial Ownership (Instr. 5)

   
 
 
 

   
 
 
 

   
 
 
 

   
 
 
 

   
 
 
 

   
 
 
 

   
 
 
 

   
 
 
 

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 reporting person, see Instruction 5(b)(v).
  (Over)
SEC 1473 (7-96)


 

FORM 3 (continued)

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


                                         
1. Title of Derivative Security
(Instr. 4)
2. Date Exercisable and Expiration Date (Month/Day/Year)
 
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)
  4. Conversion or Exercise Price of Derivative Security   5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5)   6. Nature of Indirect Beneficial Ownership (Instr. 5)

 
 
 
 
 
  Date
Exercisable
  Expiration
Date
     Title      Amount or
Number of
Shares
                       
 



                       
 

Options to Purchase Common Stock  
(1)
 
2/19/09
 
Common Stock
 
24,118
 
5.68
 
D
 
 

Options to Purchase Common Stock  
(2)
 
11/5/09
 
Common Stock
 
7,235
 
4.41
 
D
 
 

Options to Purchase Common Stock  
(3)
 
2/11/10
 
Common Stock
 
18,088
 
4.93
 
D
 
 

Options to Purchase Common Stock  
(4)
 
5/31/10
 
Common Stock
 
13,265
 
5.65
 
D
 
 

Options to Purchase Common Stock  
(5)
 
11/3/10
 
Common Stock
 
2,412
 
7.02
 
D
 
 

Options to Purchase Common Stock  
(6)
 
3/1/12
 
Common Stock
 
14,882
 
7.95
 
D
 
 

   
 
 
 
 
 
 
 
 
 
 
 
 
 

   
 
 
 
 
 
 
 
 
 
 
 
 
 

   
 
 
 
 
 
 
 
 
 
 
 
 
 

Explanation of Responses:
       
(1)  The options vest in four annual installments of 6029.50 each commencing on 2/19/2000
     
(2)  The options vest in four annual installments of 1808.75 each commencing on 11/5/2000
     
(3)  The options vest in four annual installments of 4522 each commencing on 2/11/2001
     
(4)  The options vest in four annual installments of 3316.25 each commencing on 5/31/2001
     
(5)  The options vest in four annual installments of 603 each commencing on 11/3/2001
     
(6)  The options vest in four annual installments of 3,720.50 each commencing on 3/1/2003
     
**  Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
/s/ Timothy T. Fogarty   3/22/02
 
 
Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure.
Signature of Reporting Person   Date
       
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
     
       
 
Form 3 020322 — Fogarty.wpd
   
Page 2
SEC 1473 (7-96)