FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
FIBERSTARS INC /CA/ [ FBST ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 03/23/2004 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 03/23/2004 | X | 518,000 | A | $5,180 | 1,681,079 | D | |||
Common Stock | 03/23/2004 | J(1) | 1,541,011 | D | $0.00(1) | 140,068(2) | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Warrants to Purchase Common Stock | $0.01 | 03/23/2004 | J(2) | 518,000(2) | 01/31/2000 | 01/31/2007 | Common Stock | 518,000 | $0.01 | 482,000(2) | D | ||||
Warrants to Purchase Common Stock | $0.01 | 03/23/2004 | J(2) | 75,000(2) | 01/31/2000 | 01/31/2007 | Common Stock | 75,000 | $0.01 | 407,000(2) | D |
Explanation of Responses: |
1. On March 23, 2004, Advanced Lighting Technologies, Inc. (ADLT) entered into a Second Amended and Restated Investor Agreement with the Registrant and the ADLT Class 7 Liquidating Trust (ADLT Trust) undertaking to transfer 1,541,011 shares of common stock of Fiberstars, Inc. to ADLT Trust pursuant to ADLT's plan of reorganization. These shares consisted of 1,023,011 shares held as previously reported, and 518,000 shares to be issued in respect of warrants held, as previously reported, and to be exercised. ADLT has no interest in the ADLT Trust, other than the right to reimbursement of certain expenses, and does not have or share investment or voting power over the assets of the ADLT Trust. As a result, ADLT no longer has any interest in shares of Fiberstars, other than the derivative securities reported herein. |
2. Pursuant to the Second Amended and Restated Investor Agreement, Warrants to purchase 518,000 shares are to be exercised, and the underlying shares transferred to the ADLT Trust, Warrants to purchase 75,000 shares are to be transferred, leaving Advanced Lighting with Warrants to purchase 407,000 shares, of which 140,068 shares may be acquired within 60 days. |
/s/ Christopher Zerull, Vice President and Chief Accounting Officer | 03/24/2004 | |
** Signature of Reporting Person | Date | |
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 4 (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 is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |