5 1 a69777e5.txt FORM 5 1 ---------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------- FORM 5 WASHINGTON, DC 20549 OMB APPROVAL ---------- ------------------------------- ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0362 [ ] Check box if no longer EXPIRES: September 30, 1998 subject to Section 16. Filed pursuant to Section 16(a) of the Securities ESTIMATED AVERAGE BURDEN Form 4 or Form 5 Exchange Act of 1934, Section 17(a) of the HOURS PER RESPONSE.........1.0 obligations may continue. Public Utility Holding Company Act of 1935 -------------------------------- See Instruction 1(b). or Section 30(f) of the [ ] Form 3 Holdings Reported Investment Company Act of 1940 [ ] Form 4 Transactions Reported ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) Pickup Richard H. Micro General Corp. (MGEN) --------------------------------------------- ---------------------------------------------- X Director 10% Owner (Last) (First) (Middle) 3. IRS Identification 4. Statement for --- --- Number of Reporting Month/Year 2321 Alcova Ridge Dr. Person, if an entity Officer Other --------------------------------------------- (Voluntary) December 2000 --- (give title --- (Specify title (Street) ------------------- below) below) 5. If Amendment, Las Vegas NV 89134 Date of ------------------------------- --------------------------------------------- Original 7. Individual or Joint/Group Reporting (City) (State) (Zip) (Month/Year) (Check Applicable Line) X Form filed by One Reporting --- Person Form filed by more than --- One Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of (Instr. 3) action action or Disposed of (D) Securities Form: Indirect Date Code (Instr. 3, 4 and 5) Beneficially Direct (D) Beneficial (Instr. 8) Owned at End or Ownership (Month/ ----------------------- of Fiscal Year Indirect (I) (Instr. 4) Day/ (A) or (Instr. 3 and 4) (Instr. 4) Year) Amount (D) Price ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,281,192 I Held by entities which Mr. Pickup has beneficial interests in. ------------------------------------------------------------------------------------------------------------------------------------ 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 control number. (Over) *If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). SEC 2270 (7-97)
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FORM 5 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Transaction 5. Number of 6. Date Exer- 7. Title and 8. Price of Security sion or action Code Derivative cisable and Amount of Derivative (Instr. 3) Exercise Date (Instr. 8) Securities Expiration Underlying Security Price of (Month/ Acquired (A) Date Securities (Instr. 5) Derivative Day/ or Disposed of (Month/Day/ (Instr. Security Year) (D) (Instr. 3, Year) 3 and 4) 4, and 5) ---------------- ----------------- Date Expira- Amount or ---------------- Exer- tion Number of (A) (D) cisable Date Title Shares ------------------------------------------------------------------------------------------------------------------------------------ Warrants 1.50 4/8/98 P 4/8/98 4/7/03 General 225,000 ------------------------------------------------------------------------------------------------------------------------------------ Options 80,000 ------------------------------------------------------------------------------------------------------------------------------------ Stock Options 1.31 8/27/97 8/27/99 2/9/05 Common 15,000 ------------------------------------------------------------------------------------------------------------------------------------ 4.81 10/27/98 6/3/00 10/27/08 Common 20,000 ------------------------------------------------------------------------------------------------------------------------------------ 3.63 4/8/99 4/8/99 4/8/09 Common 6,667 ------------------------------------------------------------------------------------------------------------------------------------ 3.63 4/8/99 4/8/00 4/8/09 Common 6,667 ------------------------------------------------------------------------------------------------------------------------------------ 3.63 4/8/99 4/8/01 4/8/09 Common 6,666 ------------------------------------------------------------------------------------------------------------------------------------ 4.875 11/17/99 11/17/99 11/17/09 Common 8,334 ------------------------------------------------------------------------------------------------------------------------------------ 4.875 11/17/99 11/17/00 11/17/09 Common 8,334 ------------------------------------------------------------------------------------------------------------------------------------ 4.875 11/17/99 11/17/01 11/17/09 Common 8,333 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------- 1. Title of Derivative 9. Number of 10. Ownership of 11. Nature of Security Derivative Derivative Indirect (Instr. 3) Securities Security: Beneficial Beneficially Direct (D) Ownership Owned at End or Indirect (I) (Instr. 4) of Year (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------- Warrants 225,000 I Held by entities Mr. Pickup has a beneficial interest in. ------------------------------------------------------------------------------------------------------- Options 80,000 D ------------------------------------------------------------------------------------------------------- Stock Options 80,000 ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- Explanation of Responses: **Intentional misstatements or omissions of facts constitute Federal Criminal /s/ Richard Pickup February 15, 2001 Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). -------------------------- ----------------- **Signature of Date Reporting Person Note: File three copies of this Form, one of which must be manually signed. Page 2 If space provided is insufficient, see Instruction 6 for procedure. SEC 2270 (7-97) 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.