-----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, FiOWsfUm1aI7dWatGE1tP9tZFXxuF0OC2+SzXXsOwKUWP4U143PF3ZMxcGG9XyKq mvxTpxmQV6Uzn65FJfWM1g== 0000905148-98-001871.txt : 19981015 0000905148-98-001871.hdr.sgml : 19981015 ACCESSION NUMBER: 0000905148-98-001871 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980831 FILED AS OF DATE: 19981014 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: HEI INC CENTRAL INDEX KEY: 0000351298 STANDARD INDUSTRIAL CLASSIFICATION: SEMICONDUCTORS & RELATED DEVICES [3674] IRS NUMBER: 410944876 STATE OF INCORPORATION: MN FISCAL YEAR END: 0831 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-10078 FILM NUMBER: 98725562 BUSINESS ADDRESS: STREET 1: 1495 STEIGER LAKE LN STREET 2: P O BOX 5000 CITY: VICTORIA STATE: MN ZIP: 55386 BUSINESS PHONE: 6124432500 MAIL ADDRESS: STREET 1: P O BOX 5000 STREET 2: 1495 STEIGER LAKE LANE CITY: VICTORIA STATE: MN ZIP: 55386 COMPANY DATA: COMPANY CONFORMED NAME: REYNOLDS DONALD R CENTRAL INDEX KEY: 0001060511 STANDARD INDUSTRIAL CLASSIFICATION: SEMICONDUCTORS & RELATED DEVICES [3674] OFFICER STATE OF INCORPORATION: MN FISCAL YEAR END: 0831 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 1495 STEIGER LAKE LN STREET 2: P O BOX 5000 CITY: VICTORIA STATE: MN ZIP: 55386 BUSINESS PHONE: 6124432500 MAIL ADDRESS: STREET 1: 3564 BASSWOOD CIRCLE CITY: PRIOR LAKE STATE: MN ZIP: 55372 5 1 T:\EDGAR\REYNO5.SUB FORM 5 / / Check 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 U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 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 1. Name and Address of Reporting Person 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer HEI, Inc. (HEII) (Check all applicable) Reynolds Donald R. 3. IRS or Social Security 4. Statement for Director 10% Owner (Last) (First) (Middle) Number of Reporting Month/Year --- -- Person (Voluntary) August 1998 X Officer (give ____ Other (specify --- title below) below) 14177 Sandy Beach Trail (Street) Prior Lake MN 55372 (City) (State) (Zip) 5. If Amendment, 7. Individual or Joint/Group Filing (Check Applicable Date of Original Line) (Month/Year) 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 2. Transaction Date 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature Security (Month/Day/ Code or Disposed of (D) Securities Form: of (Instr. 3) Year) (Instr. 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Indirect Owned at or Indirect Beneficial Issuer's (I)(Instr. 4) Ownership Fiscal Year (Instr. 4) (Instr. 3 and 4) Amount (A) or (D) Price - ---------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- =================================================================================================================================== ===================================================================================================================================
*If the form is filed by more than reporting person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) 1. Title of 2.Conver- 3. Trans- 4. Transac- 5. Number of 6. Date Exer- 7. Title and 8. Price 9. Number 10. Owner- 11. Na- Derivative sion or action tion Deriva- cisable Amount of of of ship ture Security Exercise Date Code tive Secur- and Expira- Underlying Deriv- Deriv- Form of In- (Instr. 3) Price of Month/ (Instr. 8) ities Ac- tion Date Securities ative ative of direct of Deriv- Day/ quired (A) (Month/Day/ (Instr. 3&4) Secur- Secur- De- Bene- ative Year) or Disposed Year) ity ities rivative ficial Security of (D) (Inst. (Instr. Bene- Secu- Own- 3,4, and 5) 5) ficially rity: ership Owned at Direct (Instr. End of (D) or 4) Month In- (Instr. 4) direct (I)(Instr. 4) Date Expira- Exer- tion Amount or cisable Date Title Number of Shares (A) (D) Stock Options 6.7425 8/28/98 J(1) 52,500 3/30/01 3/30/08 Common 52,500 9.00 0 Stock $.05 par value Explanation of Responses: (1) Pursuant to the Company's Employee Stock Option Plan, all options held by the reporting person granted under the plan became fully vested and exercisable upon the change of control which occurred in August 1998 and such options were cashed out on the basis of the change of control price (as determined under the plan). Upon such payment, all such options were cancelled. **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/Donald R. Reynolds October 13, 1998 --------------------- ---------------- See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Page 2
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