-----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, EwAEUM/PddcuL5uG9hWkQsM/UeiKefqqVL4gIFyyE2oLN0w0QUXEeUCxdVqTV3VL LsPrNe68KMXfc1bKlzjY3Q== 0001140361-02-000050.txt : 20020414 0001140361-02-000050.hdr.sgml : 20020414 ACCESSION NUMBER: 0001140361-02-000050 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010101 FILED AS OF DATE: 20020205 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: NEW BRUNSWICK SCIENTIFIC CO INC CENTRAL INDEX KEY: 0000071241 STANDARD INDUSTRIAL CLASSIFICATION: LABORATORY APPARATUS & FURNITURE [3821] IRS NUMBER: 221630072 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-06994 FILM NUMBER: 02527177 BUSINESS ADDRESS: STREET 1: 44 TALMADGE RD STREET 2: PO BOX 4005 CITY: EDISON STATE: NJ ZIP: 08818-4005 BUSINESS PHONE: 9082871200 MAIL ADDRESS: STREET 1: 44 TALMADGE ROAD STREET 2: PO BOX 4005 CITY: EDISON STATE: NJ ZIP: 08818-4005 COMPANY DATA: COMPANY CONFORMED NAME: VAN RIPER DANIEL S CENTRAL INDEX KEY: 0001138019 DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: NEW BRUNSWICK SCIENTIFIC CO INC STREET 2: 44 TALMADGE RD P O BOX 4005 CITY: EDISON STATE: NJ ZIP: 40625 BUSINESS PHONE: 7322871200 MAIL ADDRESS: STREET 1: 57 FOREMUST MOUNTAIN ROAD CITY: MUNTVILLE STATE: NJ ZIP: 07045 5 1 doc1.htm Form 5
Form 5
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

ANNUAL STATEMENT OF CHANGES
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
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[ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See instructions 1(b).
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[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
1. Name and Address of Reporting Person*
VAN RIPER, DANIEL S.
2. Issuer Name and Ticker or Trading Symbol
New Brunswick Scientific Co., Inc.   (NBSC)

6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_X_ Director                    ___ 10% Owner
___ Officer (give             ___ Other (specify
                  title below)                     below)


(Last)             (First)            (Middle)

57 FOREMOST MOUNTAIN ROAD
3. I.R.S. Identification Number of Reporting Person, if an entity
(voluntary)

###-##-####
4. Statement for Month/Year
12/2001
(Street)

MONTVILLE, NJ 07045
5. If Amendment, Date of Original (Month/Year)
7. Individual or Joint/Group Filing
(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
(City)             (State)             (Zip) 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)
5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year
(Instr. 3 and 4)
6. Owner-
ship Form:
Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A)
or
(D)
Price
COMMON STOCK             5,500 (a) D  
* If the form is filed by more than one reporting person, see instruction 4(b)(v).
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)
SEC 2270 (3-99)
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 Security
(Instr.3)
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)
7. Title and Amount of
Underlying Securities
(Instr. 3 and 4)
8. Price of
Derivative
Security
(Instr. 5)
9.Number of
Derivative
Securities
Beneficially
Owned at
End of
Year
(Instr. 4)
10. Ownership
Form of
Derivative
Security:
Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
Code V (A) (D) Date
Exercisable
Expiration
Date
Title Amount
or
Number
of Shares
COMMON STOCK OPTION $2.73 (b) 04/11/2001 A   5,500(b)     (c) 04/11/2007 COMMON STOCK 5,500(b) $2.73 (b) 5,500 (b) D  
Explanation of Responses:

(a)INCLUDES SHARES RECEIVED UPON PAYMENT OF 10% STOCK DIVIDEND ON MAY 15,2001
(b) ADJUSTED FOR 10% STOCK DIVIDEND PAID MAY 15, 2001
(c) 04/11/02 20%, 04/11/03 40%, 04/11/04 60%, 04/11/05 80%, 04/11/06 100%


** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). /s/ DANIEL S. VAN RIPER
**Signature of Reporting Person
01/24/2002 
Date
Note: File three copies of this Form, one of which must be manually signed.
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