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Gulick John A III – ‘4’ for 12/26/01 re: H E R C Products Inc.

As of:  Wednesday, 1/2/02   ·   For:  12/26/01   ·   Accession #:  950147-2-1   ·   File #:  1-13012

Previous ‘4’:  ‘4’ on 12/4/01 for 11/19/01   ·   Latest ‘4’:  This Filing

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 1/02/02  Gulick John A III                 4          Officer     1:8K   H E R C Products Inc.             Imperial Fin’l … Corp/FA

Statement of Changes in Beneficial Ownership of Securities by an Insider   —   Form 4   —   SEA’34
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 4           Form 4 for John A Gulick Iii                           3     12K 

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------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0287 Expires: December 31, 2001 Estimated average burden hours per response ....... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 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(f) of the Investment Company Act of 1940 [ ] Check this box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ================================================================================ 1. Name and Address of Reporting Person* Gulick III John Alexander -------------------------------------------------------------------------------- (Last) (First) (Middle) H.E.R.C. Products Incorporated 2215 West Melinda Lane, Suite A -------------------------------------------------------------------------------- (Street) Phoenix Arizona 85027 -------------------------------------------------------------------------------- (City) (State) (Zip) ================================================================================ 2. Issuer Name and Ticker or Trading Symbol H.E.R.C. Products Incorporated (HERC) ================================================================================ 3. IRS or Social Security Number of Reporting Person (Voluntary) ================================================================================ 4. Statement for Month/Year December 2001 ================================================================================ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) Vice President ================================================================================ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [ ] Form filed by more than one Reporting Person ================================================================================ Page 1 of 3
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Form 4 (continued) Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned [Enlarge/Download Table] ======================================================================================= Amount of Securities Secur- Nature Acquired (A) ities Owner- of or Disposed Bene- ship Indirect of (D) (Instr. ficially Form: Bene- Transaction 3, 4 and 5) Owned at Direct ficial Code ---------------- End (D) or Owner- Title of Transaction (Instr. 8) (A) of Month Indirect ship Security Date ----------- Amount or Price (Instr. (I) (Instr. (Instr. 3) (mm/dd/yy) Code V (D) 3 and 4) (Instr.4) 4) --------------------------------------------------------------------------------------- Common Stock 12/26/01 P 16,500 A $.14 327,500 D --------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ======================================================================================= * 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. Page 2 of 3
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Form 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) [Enlarge/Download Table] ====================================================================================================================== Number Number Owner- of of ship Deriv- Title and Deriv- of Conver- ative Amount of ative Deriv- sion Secur- Underlying Secur- ative Nature of ities Securities ities Secur- of Exer- Acquired Date (Instr. 3 Price Bene- ity: In- cise Trans- (A) or Exercisable and and 4) of ficially Direct direct Price Trans- action Disposed Expiration Date ------------- Deriv- Owned (D) or Bene- of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr.3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ -------- Exer- tion of (Instr. (Instr. (Instr (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ---------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- ====================================================================================================================== Explanation of Responses: /s/ John Alexander Gulick III January 2, 2002 ------------------------------- ---------------- John Alexander Gulick III Date **Signature of Reporting Person ** 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 procedures. Page 3 of 3

Dates Referenced Herein   and   Documents Incorporated by Reference

Referenced-On Page
This ‘4’ Filing    Date First  Last      Other Filings
Filed on:1/2/023
12/31/01110KSB40,  ARS
For Period end:12/26/01
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Filing Submission 0000950147-02-000001   –   Alternative Formats (Word / Rich Text, HTML, Plain Text, et al.)

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