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As Of Filer Filing For·On·As Docs:Size Issuer 2/25/03 Chan Anthony K 5 Officer 1:8K Pacific Systems Control Tech Inc. |
Document/Exhibit Description Pages Size 1: 5 Form 5 for Chan HTML 11K
Form 5 for PACIFIC SYSTEMS CONTROL TECHNOLOGY, INC. filed on Feb 25, 2003
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL 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
[X] 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
(Print or Type Responses)
====================================================================================
1. Name and Address of Reporting Person*
Chan Anthony K. ------------- ----------------- ---------------------- (Last) (First) (Middle) 100 Marine Parkway, Suite 325 ------------------------------------------------------------------------------- (Street) Redwood Shores California 94065 --------------------- ------------------- ----------------------------------- (City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
PACIFIC SYSTEMS CONTROL TECHNOLOGY, INC. (OTC:BB - "PFSY")
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
February 2003
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[ ] Director [ ] 10% Owner [ ] Officer (give title below) [ ] Other (specify below)
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7. Individual or Joint/Group Filing
(Check Applicable Line)
[X] Form filed by one Reporting Person
[ ] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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4. Securities Acquired (A) 5. Amount of 6. Owner-
or Disposed of (D) Securities ship Form:
3. Transac- (Instr. 3, 4 and 5) Beneficially Direct 7. Nature
2. Transac- tion Code -------------------------- Owned at End (D) or of Indirect
tion Date (Instr. 8) (A) of Month Indirect Beneficial
1. Title of Security (Month/Day ------------ or (Instr. 3 (I) Ownership
(Instr. 3) Year) Code V Amount (D) Price and 4) (Instr. 4) (Instr. 4)
-------------------- ------------ ----- ----- ---------- ---- ---------- ------------ ---------- ----------
Common 376,485 (D)
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* 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
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Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
====================================================================================
9. 10.
Number Owner-
of ship
2. Deriv- Form of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Transac- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date tion Code (Instr. 3, ------------------ or Secur- of direct Owner-
Derivative ative (Month/ (Instr. 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)
---------- ------- ------- ----- ---- ----- ----- -------- -------- -------- ------- ------- -------- ------ -------
Option $28.875 07/01/99 06/30/03 Common 5,000 5,000 (D)
Option $ 5.000 12/30/99 12/29/08 Common 15,000 15,000 (D)
Option $ 4.125 11/19/99 05/18/09 Common 25,000 25,000 (D)
Option $ 3.750 06/07/01 06/06/09 Common 250,000 250,000 (D)
Option $ 2.125 01/10/01 01/09/10 Common 35,000 35,000 (D)
Option $ 0.300 12/28/00 12/27/05 Common 300,000 300,000 (D)
Option $ 0.009 11/01/02 11/01/06 Common 200,000 200,000 (D)
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Explanation of Responses:
The reporting person has resigned from the board of directors and the position of Chief Executive Officer of Pacific Systems Control Technology, Inc. as of February 12, 2003.
/s/ Anthony K. Chan February 25, 2003
------------------------------------------ ----------------------
**Signature of Reporting Person Date
** Intentional misstatements 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.
| This ‘5’ Filing | Date | Other Filings | ||
|---|---|---|---|---|
 | ||||
| Filed on: | 2/25/03 | None on these Dates | ||
| For Period end: | 2/12/03 | |||
| List all Filings | ||||