-----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, GtQEbGlH5CIGQ2EBPDdMNXCjHF+k4GDrvA+w/wchNMpuFziGwLH4oAOzlPF/hdf/ Kn7GRa940V63+xG9lhR7HA== 0001077357-99-000018.txt : 19990219 0001077357-99-000018.hdr.sgml : 19990219 ACCESSION NUMBER: 0001077357-99-000018 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981231 FILED AS OF DATE: 19990218 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SURGICAL SAFETY PRODUCTS INC CENTRAL INDEX KEY: 0001063530 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 650565144 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-24921 FILM NUMBER: 99544911 BUSINESS ADDRESS: STREET 1: 2018 OAK TERRACE CITY: SARASOTA STATE: FL ZIP: 34231 BUSINESS PHONE: 9419277874 MAIL ADDRESS: STREET 1: 2018 OAK TERRACE CITY: SARASOTA STATE: FL ZIP: 34231 COMPANY DATA: COMPANY CONFORMED NAME: SURGICAL SAFETY PRODUCTS INC CENTRAL INDEX KEY: 0001063530 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] DIRECTOR IRS NUMBER: 650565144 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 2018 OAK TERRACE CITY: SARASOTA STATE: FL ZIP: 34231 BUSINESS PHONE: 9419277874 MAIL ADDRESS: STREET 1: 2018 OAK TERRACE CITY: SARASOTA STATE: FL ZIP: 34231 5 1 ANNUAL STATEMENT OF CHANGES FORM 5 OMB Approval OMB Number 3235-0362 Expires: February 1, 1994 U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICAL 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 if no longer subject to Section 16, Form 4 or Form 5, Obligation may continue. See Instructions _X_ Form 3 Holdings Reported ___ Form 4 Transaction 1. Name and Address of Reporting Person: Clark, Frank M 2018 Oak Terrace Sarasota, FL 34231 2. Issuer Name and Tickler or Trading Symbol: Surgical Safety Products, Inc. SURG 3. IRS or SSN of Reporting Person (Voluntary): 4. Statement for Month/Year December 1998 5. If Amendment, Date of Original: 6. Relation of Reporting Person to Issuer: X Director _ 10% owner X Officer (Title):President _ Other (Specify): X Filed by One Reporting Person. _ Filed by more than One Reporting Person.
TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED 1. Title of Security: Common Stock C.S. Warrants 2. Amount of Securities Beneficially Owned: 50,000 200,000 3. Ownership Form; Direct (D) or Indirect (I): D D 4. Nature of Indirect Beneficial Ownership: N/A N/A
*If the form is filed by more than one Reporting Person, see instruction 5(b)(v) Reminder: Report on a separate Line for each class of securities beneficially owned directly or indirectly. FORM 5 (continued) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED 1. Title of Derivative Security: N/A 2. Date Exercisable and Expiration Date: 3. Title and Amount of Underlying Securities: 4. Conversion or Exercise Price of Derivative Securities: 5. Ownership of Derivative Securities; Direct (D) or Indirect (I): 6. Nature of Indirect Benefical Ownership:
EXPLANATION OF RESPONSES: /s/ Frank M. Clark Date: 2/15/99 - -------------------------------- **Signature of Reporting Person Frank M. Clark President **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See Sections 18 U.S.C. 1001, 15 U.S.C. 78ff(a).
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