On: Thursday, 2/14/02 · For: 12/31/01 · Accession #: 909334-2-24 · File #: 1-13771
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As Of Filer Filing For·On·As Docs:Size Issuer Agent
2/14/02 Schlesinger James R 5 Director 1:6K Seven Seas Petroleum Inc McAfee & Taft A..Corp/FA
Annual Statement of Change in Beneficial Ownership of Securities — Form 5
Filing Table of Contents
Document/Exhibit Description Pages Size
1: 5 James Schlesinger 2001 Form 5 4± 12K
[ ] Check this 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
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
ANNUAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
1. Name and Address of Reporting Person
(Last) (First) (Middle)
Schlesinger James R.
(Street) (City) (State) (Zip)
5555 San Felipe, Suite 1700 Houston Texas 77056
2. Issuer Name and Ticker or Trading Symbol
Seven Seas Petroleum Inc. (SEV)
3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)
4. Statement for Month/Year
5. If Amendment, Date of Original (Month/Year)
6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[ X ] Director [ ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
7. Individual or Joint/Group Reporting
(Check applicable line)
[ X ] Form Filed by One Reporting Person
[ ] Form Filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)
2. Transaction Date (Month/Day/Year)
3. Transaction Code (Instr. 8)
4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
Amount (A) or (D) Price
5. Amount of Securities Beneficially Owned at the end of Issuer's Fiscal Year
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
7. Nature of Indirect Beneficial Ownership (Instr. 4)
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)
(a) Stock Option (Right to Buy)
(b) Stock Option (Right to Buy)
(c) Stock Option (Right to Buy)
(d) Stock Option (Right to Buy)
(e) Stock Option (Right to Buy)
(f) Series A Warrants
2. Conversion or Exercise Price of Derivative Security
3. Transaction Date (Month/Day/Year)
4. Transaction 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)
Date Exercisable Expiration Date
(a) (1) (a) 07/30/06
(b) (1) (b) 07/30/06
(c) (1) (c) 07/30/06
(d) (1) (d) 07/30/06
(e) (1) (e) 07/11/11
(f) (4) (f) 06/30/08
7. Title and Amount of Underlying Securities (Instr. 3 and 4)
Title Amount or Number of Shares
(a) Common Stock (a) 5,422
(b) Common Stock (b) 5,422
(c) Common Stock (c) 5,422
(d) Common Stock (d) 5,422
(e) Common Stock (e) 20,000
(f) Common Stock (f) 134,608
8. Price of Derivative Security (Instr. 5)
9. Number of Derivative Securities Beneficially Owned at End of Year (Instr.
10. Ownership of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
11. Nature of Indirect Beneficial Ownership (Instr. 4)
Explanation of Responses:
(1) Immediately upon grant
(2) Each of the grants of 5,422 options identified herein was granted to Dr.
Schlesinger in lieu of $10,625 cash compensation.
(3) The 20,000 shares were granted to Dr. Schlesinger for his services as
director of the Issuer in 2001, 2002 and 2003.
(4) Exercisable on 02/01/02 upon registration with SEC of underlying shares.
(5) The Series A Warrants were purchased as part of a unit that also included a
$100 Series A Senior Secured Note. The unit was purchased for $100 plus
accrued interest. The allocated fair market value of the Series A Warrant
has been estimated at $5.10.
/s/ James R. Schlesinger 02/13/02
**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. If
space provided is insufficient, see Instruction 6 for procedure.
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.
Filing Submission 0000909334-02-000024 – Alternative Formats (Word / Rich Text, HTML, Plain Text, et al.)
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