5 1 file001.txt FORM 5 FORM 5 _________________________________ [ ] Check this box if no longer subject | OMB APPROVAL | to Section 16. Form 4 or Form 5 _________________________________ obligations may continue. See | OMB Number: 3235-0287| Instruction (b). | Expires: December 31, 2001| [ ] Form 3 Holdings Reported | Estimated average burden | [ ] Form 4 Holdings Reported | hours per response....... 0.5| _________________________________ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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(f) of the Investment Company Act of 1940 -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Tolbert John David ----------------------------------------------------- (Last) (First) (Middle) 345 S. High Street, Suite 201 ----------------------------------------------------- (Street) Muncie IN 47305 ----------------------------------------------------- (City) (State) (Zip) -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Alltrista Corporation (ALC) -------------------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) -------------------------------------------------------------------------------- 4. Statement for Month/Year December 31, 2001 -------------------------------------------------------------------------------- 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) Vice President, Human Resources and Administration -------------------------------------------------- -------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Law) [X] Form filed by One Reporting Person [ ] Form filed by More than One Reporting Person ------------------------------------------------------------------------------- Page 1 FORM 5 (continued)
TABLE I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. ------------------------------------------------------------------------------------------------------------------------ Amount of Owner- Trans- Securities ship action Trans- Beneficially Form: Date action Owned at End Direct Nature of -------- Code Securities Acquired (A) of Issuer's (D) or Indirect Title of (Month/ (Instr. 8) or Disposed of (D) Fiscal Year Indirect Beneficial Security Day/ ---------- ---------------------------- (Instr. (I) Ownership (Instr. 3) Year) Code Amount (A) or (D) Price 3 and 4) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------
Page 2 FORM 5 (continued)
TABLE II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g. puts, calls, warrants, options, convertible securities) ------------------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. ------------------------------------------------------------------------------------------------------------------------------------ Title and Ownership Number of Date Exer- Amount of Form of Derivative cisable and Underlying Number of Deriv- Securities Expiration Securities Price Derivative ative Conver- Acquired (A) Date (Month/ (Instr. 3 of Securities Security: sion or Trans- or Disposed Day/Year) and 4) Deriv- Benefi- Direct Exercise action Trans- of (D) -------------- -------------- ative cially (D) or Nature of Title of Price of Date action (Instr. 3, Date Amount Secur- Owned at Indirect Indirect Derivative Deriv- (Month/ Code 4 and 5) Exer- Expir- or Num- ity End of (I) Beneficial Security ative Day/ (Instr. ---------- cis- ation ber of (Instr. Year (Instr. Ownership (Instr. 3) Security Year) 8) (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Stock Options (Right to Common Buy) (1) $10.95 9/24/01 A 15,000 (2) 9/24/11 Stock 15,000 15,000 D ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
(1) Granted pursuant to the Alltrista Corporation 2001 Stock Option Plan. (2) Presently exercisable. 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. 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. 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. /s/ John David Tolbert February 12, 2002 ---------------------------------------- -------------------- ** Signature of the Reporting Person Date (Over) SEC 1474 (7/96) Page 3