5 1 mcg092802-5.txt FORM 5 9/28/02 5 1 NONE 0001017465 xqo@x5ob Officer INSTEEL INDUSTRIES, INC. 0000764401 56-0674867 09/28/02 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP [ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. [ ] Form 3 Holdings Reported [ ] Form 4 Transactions Reported 1. Name and Address of Reporting Person(s) Gazmarian, Michael C. 1373 BOGGS DRIVE MOUNT AIRY, NORTH CAROLINA 27030 2. Issuer Name and Ticker or Trading Symbol INSTEEL INDUSTRIES, INC. (IIIN) 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) 4. Statement for Month/Year 09/02 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) Treasurer 7. Individual or Joint/Group Filing (Check Applicable Line) [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 2)Trans- 3.Trans- 4.Securities Acquired(A) 5)Amount of 6) 7)Nature of action action or Disposed of (D) Securities Indirect Date Code A Beneficially D Beneficial (Month/ or Owned at or Ownership Day/Year) Code Amount D Price End of Year I ------------------------------------------------------------------------------------------------------------------------------------ Table II (PART 1) Derivative Securitites Acquired, Disposed of, or Beneficially Owned (Columns 1 through 6) ------------------------------------------------------------------------------------------------------------------------------------ 1)Title of Derivative 2)Conversion 3)Trans- 4)Trans- 5)Number of Derivative 6)Date Exercisable and Security or Exercise action action Securities Acquired (A) Expiration Date Price of Date Code or Disposed of (D) Derivative Security Code A D Exercisable Expiration ------------------------------------------------------------------------------------------------------------------------------------ Incentive Stock Option (right $0.3500 02/19/02 A 32,398.00 02/19/12 to buy) Non-Qualified Stock Option $0.3500 02/19/02 A 5,602.00 02/19/12 (right to buy) Table II (PART 2) Derivative Securitites Acquired, Disposed of, or Beneficially Owned (Columns 1,3 and 7 through 11) ------------------------------------------------------------------------------------------------------------------------------------ 1)Title of Derivative 3)Trans- 7)Title and Amount 8)Price 9)Number of 10) 11)Nature of Security action of Underlying of Deri- Derivative Indirect Date Securities vative Securities D Beneficial Amount or Security Beneficially or Ownership Number of Owned at I - Title Shares End of Year ------------------------------------------------------------------------------------------------------------------------------------ Incentive Stock Option (right 02/19/02 Common Stock 32,398.00 32,398.00 D Direct to buy) Non-Qualified Stock Option 02/19/02 Common Stock 5,602.00 5,602.00 D Direct (right to buy) Explanation of Responses:
SIGNATURE OF REPORTING PERSON /S/ Gazmarian, Michael C. DATE 10/22/02