-----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, FNWS+gRm2+0q8vn7XtsFygOsh3sTYhSd6SkfVmjwjHSwZEcBcLxKOCR93468BsjD kbdcWClwfZtjCdeFuTP+bg== 0000950136-02-000406.txt : 20020414 0000950136-02-000406.hdr.sgml : 20020414 ACCESSION NUMBER: 0000950136-02-000406 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20011231 FILED AS OF DATE: 20020214 COMPANY DATA: COMPANY CONFORMED NAME: EHRLICH BURTT R CENTRAL INDEX KEY: 0001014013 DIRECTOR STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 20 BRYNWOOD LANE CITY: GREENWICH STATE: CT ZIP: 06831 MAIL ADDRESS: STREET 1: 20 BRYNWOOD LANE CITY: GREENWICH STATE: CT ZIP: 06831 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: LANGER INC CENTRAL INDEX KEY: 0000725460 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 112239561 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12991 FILM NUMBER: 02545840 BUSINESS ADDRESS: STREET 1: 450 COMMACK ROAD CITY: DEER PARK STATE: NY ZIP: 11729 BUSINESS PHONE: 6136671200 MAIL ADDRESS: STREET 1: 450 COMMACK ROAD CITY: DEER PARK STATE: NY ZIP: 11729 5 1 file001.txt FORM 5 ----------------------------------- OMB APPROVAL ----------------------------------- OMB Number 3235-0287 Expires: December 31, 2001 Estimated average burden hours per response............. 0.5 ----------------------------------- - ------------------------------ FORM 5 - ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
[ ] Check this box if no longer subject to Section 16. Form 4 Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public or Form 5 obligations Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 may continue. See Instruction (b). [ ] Form 3 Holdings Reported [X] Form 4 Holdings Reported
---------------------------------- ------------------------------------------------------------------------ 1. Name and Address of Reporting 2. Issuer Name and Ticker or Trading Symbol Person* Ehrlich Burtt R. Langer, Inc. (GAIT) ---------------------------------- ------------------------------------ ---------------------------------- (Last) (First) (Middle) 3. IRS or Social Security Number 4. Statement for Month/Year of Reporting Person (Voluntary) 20 Brynwood Lane December 31, 2001 ---------------------------------- ------------------------------------ ---------------------------------- (Street) 5. If Amendment, Date of Original (Month/Year) Greenwich CT 06831 ---------------------------------- ------------------------------------------------------------------------------------------- (City) (State) (Zip) ---------------------------------- ------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) x Director 10% Owner -------- ------ Officer (give Other -------- ------ title below) (specify below) -------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Law) 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 Security (Instr. 3) 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- action action or Disposed of (D) Securities ship Date Code Beneficially Form: (Instr. Owned at End of (D) Dir 8) Issuer's Fiscal ect or (I) Year (Instr. 3 Indirect and 4) (Instr. 4) ---------------------------------- ---------- ---------- ------ ------------ -------- ------------------- ------------- (Month/Day Code Amount (A) or (D) Price /Year) ---------------------------------- ---------- ---------- ------ ------------ -------- ------------------- ------------- Common Stock, par value $0.02 per 91,474 D share ---------------------------------- ---------- ---------- ------ ------------ -------- ------------------- ------------- Common Stock, par value $0.02 per 31,500 I share ---------------------------------- ---------- ---------- ------ ------------ -------- ------------------- ------------- Common Stock, par value $0.02 per 13,500 I share ---------------------------------- ---------- ---------- ------ ------------ -------- ------------------- ------------- Common Stock, par value $0.02 per 15,100 I share ---------------------------------- ---------- ---------- ------ ------------ -------- ------------------- ------------- Common Stock, par value $0.02 per 19,900 I share ---------------------------------- ---------- ---------- ------ ------------ -------- ------------------- ------------- ------------------------------------------------------------ 7. Nature Indirect Beneficial Ownership (Instr. 4) ------------------------------------------------------------ ------------------------------------------------------------ ------------------------------------------------------------ By trust f/b/o David Ehrlich (1) ------------------------------------------------------------ By trust f/b/o Julie Ehrlich (1) ------------------------------------------------------------ By David Ehrlich (1) ------------------------------------------------------------ By Julie Ehrlich (1) ------------------------------------------------------------
FORM 5 (continued) 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. Trans- 5. Number of 6. Date Exercisable 7. Title and Amount of Derivative sion or action action Derivative and Expiration Underlying Securities Security Exercise Date Code Securities Date (Month/Day/Year) (Instr. 3 and 4) (Instr. 3) Price of (Month/ (Instr. Acquired (A) Derivative Date/ 8) or Disposed of (D) Security Year) (Instr. 3, 4, and 5) ----------- ----------- ------------ ----------- ---------- ----------------- Amount or Date Expiration Number of (A) (D) Exercisable Date Title Shares -------------- ----------- ---------- ---------- ----------- ----------- ------------ ---------- ----------- ----------------- Stock Options $1.525 (2) 2/13/11 Common 30,000 (Right to Buy) Stock -------------- ----------- ---------- ---------- ----------- ----------- ------------ ---------- ----------- ----------------- 4% Convertible $6.00 10/31/01 P4 $50,000 (2) 8/31/06 Common 8,333 Subordinated Stock Notes -------------- ----------- ---------- ---------- ----------- ----------- ------------ ---------- ----------- ----------------- 4% Convertible $6.00 10/31/01 P4 $50,000 (2) 8/31/06 Common 8,333 Subordinated Stock Notes -------------- ----------- ---------- ---------- ----------- ----------- ------------ ---------- ----------- ----------------- -------------- ----------- ---------- ---------- ----------- ----------- ------------ ---------- ----------- ----------------- -------------- ----------- ---------- ---------- ----------- ----------- ------------ ---------- ----------- ----------------- -------------- ------------- ------------ ---------------- 8. Price of 9. Number 10 Owner- 11. Nature Deriv of deriv- ship of Indirect ative ative Form of Beneficial Sec- Secur- Deriv- Ownership urity ities ative (Instr. 4) (Inst. Bene- Security: 5) ficially Direct Owned (D) or at End Indirect of Year (I) (Instr. 4) (Instr. 4) -------------- ------------- ------------ ---------------- 30,000 D -------------- ------------- ------------ ---------------- $50,000 I By trust f/b/o David Ehrlich (3) -------------- ------------- ------------ ---------------- $50,000 I By trust f/b/o David Ehrlich (3) -------------- ------------- ------------ ---------------- -------------- ------------- ------------ ---------------- (1) Represents part of 80,000 shares of the issuer's common stock held in trust or in a custodial account for Burtt Ehrlich's children. The reporting person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the reporting person is the beneficial owner of these securities for the purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise. (2) Presently exercisable. (3) The two convertible notes to which this report relates are held in trust for Burtt Ehrlich's children and are each $50,000 in principal amount and convertible into 8,333 shares of the issuer's common stock. The reporting person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the reporting person is the beneficial owner of these securities for the purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise. Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. *If the Form is filed by more than one reporting person, See Instruction 5(b)(v).
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Burtt R. Ehrlich February 13, 2002 See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). --------------------- ----------------- **Signature of the Date Reporting Person
Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, See Instruction 6 for procedure. 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. (Over) SEC 1474 (7/96) -----END PRIVACY-ENHANCED MESSAGE-----