-----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, Qlg6IOLKOLOdq+Dl0ebylkx2yaTT4jFMENK58Y6WMKyeCODtwkLTTzL9K76TIqCQ snlzLJP8cIhe3OYz7zl7ng== 0000891618-03-000634.txt : 20030210 0000891618-03-000634.hdr.sgml : 20030210 20030207181006 ACCESSION NUMBER: 0000891618-03-000634 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030210 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: VAN VALKENBURG DAVID R CENTRAL INDEX KEY: 0001216442 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 5 MAIL ADDRESS: STREET 1: HARMONIC INC STREET 2: 549 BALTIC WAY CITY: SUNNYVALE STATE: CA ZIP: 94089 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: HARMONIC INC CENTRAL INDEX KEY: 0000851310 STANDARD INDUSTRIAL CLASSIFICATION: RADIO & TV BROADCASTING & COMMUNICATIONS EQUIPMENT [3663] IRS NUMBER: 770201147 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25826 FILM NUMBER: 03545605 BUSINESS ADDRESS: STREET 1: 549 BALTIC WAY CITY: SUNNYVALE STATE: CA ZIP: 94089 BUSINESS PHONE: 4085422500 FORMER COMPANY: FORMER CONFORMED NAME: HARMONIC LIGHTWAVES INC DATE OF NAME CHANGE: 19950404 5 1 f87487dve5.htm FORM 5 Harmonic Inc. Form 5 David Van Valkenburg
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

FORM 5

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(h) of the Investment Company Act of 1940

o Check box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
o Form 3 Holdings Reported
o Form 4 Transactions Reported

1. Name and Address of Reporting
Person*
2. Issuer Name and Ticker or Trading
Symbol
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Van Valkenburg, David
(Last) (First) (Middle)
  Harmonic Inc. (HLIT)
 
   
                 
  549 Baltic Way
4. Statement for Month/Year 5. If Amendment, Date of Original (Month/Year)
    December 2002
 
  (Street) 6. Relationship of Reporting Person(s)
to Issuer
(Check All Applicable)
7. Individual or Joint/Group Reporting
(Check Applicable Line)
  Sunnyvale, CA 94089
(City)        (State)        (Zip)
  x  Director o  10% Owner   x Form filed by One Reporting Person
    o  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)  
     
     

*   If the form is filed by more than one reporting person, see instruction 4(b)(v).


 

                                                 

Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of
Security

(Instr. 3)
2. Transaction
Date

(Month/Day/Year)
2A. Deemed Execution
Date, if any

(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 the End of Issuer's
Fiscal Year

(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)

(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

                    Amount (A)
or
(D)
Price            

                     

                     

                     

                     

                     

                     

                     

Page 2


 


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)
3A. Deemed Execution
Date, if any

(Month/Day/Year)
4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)

(Instr. 3, 4 and 5)

                            (A) (D)

  Common Stock (right to buy)     $8.65     5/17/02     A   20,000

               

               

               

               

               

               

               

               

Page 3


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

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 of
Derivative Security:
Direct (D)
or Indirect (I)

(Instr. 4)
11. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

  Date
Exercisable
Expiration
Date
  Title Amount or
Number of
Shares
                       

  (1) 5/17/12   Common Stock 20,000           20,000     D  

                   

                   

                   

                   

                   

                   

                   

                   

Explanation of Responses:

(1) Exercisable in monthly installments over a period of three years from Date of Grant, so that one hundred percent shall be exercisable three years after Date of Grant.

/s/ Laura Donovan   February 10, 2003

**Signature of Reporting Person
By: Laura Donovan
Attorney-in-Fact
 
Date


**   Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
 
Note:   File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure.

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