-----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, TIwuzWM858PnoInvAFRIxEgAXh88CKawAd4/Ga6FRPxurpRgGpEH5xXzJhQZX/Os KxMO2tekuqZaFYbFSuN7Iw== 0000950144-99-001835.txt : 19990217 0000950144-99-001835.hdr.sgml : 19990217 ACCESSION NUMBER: 0000950144-99-001835 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981201 FILED AS OF DATE: 19990216 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: KELLSTROM INDUSTRIES INC CENTRAL INDEX KEY: 0000918275 STANDARD INDUSTRIAL CLASSIFICATION: AIRCRAFT ENGINES & ENGINE PARTS [3724] IRS NUMBER: 133753725 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-23764 FILM NUMBER: 99540393 BUSINESS ADDRESS: STREET 1: 1100 INTERNATIONAL PARKWAY CITY: SUNRISE STATE: FL ZIP: 33325 BUSINESS PHONE: 9548450427 MAIL ADDRESS: STREET 1: 1100 INTERNATIONAL PARKWAY CITY: SUNRISE STATE: FL ZIP: 33325 FORMER COMPANY: FORMER CONFORMED NAME: ISRAEL TECH ACQUISITION CORP DATE OF NAME CHANGE: 19940301 COMPANY DATA: COMPANY CONFORMED NAME: STERN YOAV CENTRAL INDEX KEY: 0001000140 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: SAWGRASS CORPORATE INDUSTRIAL PARK STREET 2: 14000 NW 4TH ST CITY: SUNRISE STATE: FL ZIP: 33325 BUSINESS PHONE: 9544682450 MAIL ADDRESS: STREET 1: SAWGRASS CORPORATE INDUSTRIAL PARK STREET 2: 14000 NW 4TH ST CITY: SUNRISE STATE: FL ZIP: 33325 FORMER COMPANY: FORMER CONFORMED NAME: STERN YOAV ET AL DATE OF NAME CHANGE: 19950901 5 1 KELLSTROM INDUSTRIES/YOAV STERN FORM 5 1 - ------ FORM 5 - ------ / / CHECK BOX IF NO U.S. SECURITIES AND EXCHANGE COMMISSION LONGER SUBJECT TO WASHINGTON, DC 20549 SECTION 16. FORM 4 OR FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OBLIGATIONS MAY CONTINUE. SEE Filed pursuant to Section 16(a) of the Securities INSTRUCTION 1(b) Exchange Act of 1934, / / FORM 3 HOLDINGS Section 17(a) of the Public Utility REPORTED Holding Company Act of 1935 or Section 30(f) of / / FORM 4 the Investment Company Act TRANSACTIONS of 1940 REPORTED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Stern Yoav Kellstrom Industries, Inc. (KELL) Issuer (Check all applicable) - ------------------------------------------- ---------------------------------------------- X Director 10% Owner (Last) (First) (Middle) 3. IRS Identification 4. Statement for ---- --- 98 Battery Stret Number of Reporting Month/Year Officer (give Other (specify - ------------------------------------------- Person, if an Entity 12/98 ---- title --- below) (Street) (Voluntary) ------------------- below) San Francisco CA 94111 5. If Amendment, - ------------------------------------------- Date of Original ------------------------------- (City) (State) (Zip) (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 - ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature (Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In- Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct (Instr. End of Issuer's Direct Benefi- (Month/ 8) Fiscal Year (D) or cial Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner- Year) Amount (A) or Price (I) ship (D) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock -- -- -- -- -- 200,865 shares D N/A - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock -- -- -- -- -- 19,500 shares I (1) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ *If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses)
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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 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price Security sion or action action Derivative cisable and of Underlying of (Instr. 3) Exercise Date Code Securities Expiration Securities Deriv- Price of (Month/ (Instr. Acquired (A) Date (Instr. 3 and 4) ative Deriv- Day/ 8) or Disposed (Month/Day/ Secur- ative Year) of (D) Year) ity Security (Instr. 3, (Instr. 5) 4, and 5) ----------------------------------- Date Expira- Amount or --------------- Exer- tion Title Number of (A) (D) cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options $10.125/sh. 10/08/98 A 176,000 -- (2) 10/08/08 Common 176,000 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options $10.125/sh. 10/08/98 A 107,000 -- 12/19/99 10/08/08 Common 107,000 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options $18.63/sh. 10/08/98 D -- 176,000 (3) 10/27/07 Common 176,000 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options $25.75/sh. 10/08/98 D -- 107,000 06/19/99 06/19/08 Common 107,000 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options $8.38/sh. -- -- -- -- (4) 01/02/07 Common 245,000 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options $7.63/sh. -- -- -- -- (5) 09/19/06 Common 100,000 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options $5.00/sh. -- -- -- -- (6) 09/07/05 Common 49,000 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Warrants $26.00/sh. 12/18/98 A 5,000 -- immed. 06/17/01 Common 5,000 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Warrants $19.00/sh. -- -- -- -- immed. 09/09/02 Common 5,250 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Warrants $22.00/sh. -- -- -- -- immed. 09/09/00 Common 2,250 -- (Right to buy) Stock - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------- 1. Title of Derivative 9. Number of 10. Ownership 11. Nature of Security Derivative of Derivative Indirect (Instr. 3) Securities Security: Beneficial Beneficially Direct (D) Ownership Owned at End or Indirect (I) (Instr. 4) of Year (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------- Employee Stock Options 176,000 D N/A (Right to buy) - ------------------------------------------------------------------------------------------------------- Employee Stock Options 107,000 D N/A (Right to buy) - ------------------------------------------------------------------------------------------------------- Employee Stock Options 0 D N/A (Right to buy) - ------------------------------------------------------------------------------------------------------- Employee Stock Options 0 D N/A (Right to buy) - ------------------------------------------------------------------------------------------------------- Employee Stock Options 245,000 D N/A (Right to buy) - ------------------------------------------------------------------------------------------------------- Employee Stock Options 100,000 D N/A (Right to buy) - ------------------------------------------------------------------------------------------------------- Employee Stock Options 49,000 D N/A (Right to buy) - ------------------------------------------------------------------------------------------------------- Warrants 5,000 I (7) (Right to buy) - ------------------------------------------------------------------------------------------------------- Warrants 5,250 I (7) (Right to buy) - ------------------------------------------------------------------------------------------------------- Warrants 2,250 I (7) (Right to buy) - ------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) These shares of Common Stock are held directly by Helix Capital II, L.L.C., which is controlled, in part, by Mr. Stern. (2) These Employee Stock Options vest in two equal installments on 4/27/99 and 10/27/00. (3) These Employee Stock Options were to vest in two equal installments on 10/27/98 and 10/27/99. (4) These Employee Stock Options were acquired 01/02/97 and vest in two equal installments on 01/02/98 and 01/02/99. (5) These Employee Stock Options were acquired 09/19/96 and vest in three equal installments on 09/19/97, 09/19/98 and 09/19/99. (6) These Employee Stock Options were acquired 09/07/95 and vest in three equal installments on 09/07/96, 09/07/97 and 09/07/98. (7) These Warrants are held by Helix Capital II, L.L.C., which is controlled, in part, by Mr. Stern. **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Yoav Stern 2/11/99 See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- ------- **Signature of Reporting Person Date Note. File three copies of this form, one of which must be manually signed. Page 2 If space provided is insufficient, see Instruction 6 for procedure.
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