-----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, EImY2umSRphsuP5Pp6d5eWbeXe//6rB88IzF17Bl4dnRvBilKMv5wgVh1FyMaL4G 821qwnZl7aaWvgGnMOqJ7w== 0000950153-01-000218.txt : 20010223 0000950153-01-000218.hdr.sgml : 20010223 ACCESSION NUMBER: 0000950153-01-000218 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001231 FILED AS OF DATE: 20010214 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTERNATIONAL FIBERCOM INC CENTRAL INDEX KEY: 0000924632 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373] IRS NUMBER: 860271282 STATE OF INCORPORATION: AZ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 001-13278 FILM NUMBER: 1546068 BUSINESS ADDRESS: STREET 1: 3410 E UNIVERSITY STREET 2: SUITE 180 CITY: PHOENIX STATE: AZ ZIP: 85034 BUSINESS PHONE: 6029411900 MAIL ADDRESS: STREET 1: 3410 E UNIVERSITY STREET 2: SUITE 180 CITY: PHOENIX STATE: AZ ZIP: 85034 COMPANY DATA: COMPANY CONFORMED NAME: JENSEN C JAMES CENTRAL INDEX KEY: 0001088003 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 101 WILD OAK COURT CITY: DANVILLE STATE: CA ZIP: 94506 MAIL ADDRESS: STREET 1: 101 WILD OAK COURT CITY: DANVILLE STATE: CA ZIP: 94506 5 1 p64622ce5.txt FORM 5 - JAMES JENSEN 1 --------------------------- OMB APPROVAL --------------------------- - ------ OMB Number: 3235-0362 FORM 5 Expires: December 31, 2001 - ------ Estimated average burden hours per response .... 1.0 --------------------------- / / Check box if no UNITED STATES SECURITIES AND EXCHANGE COMMISSION longer subject to WASHINGTON, D.C. 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(s) Jensen James C. INTERNATIONAL FIBERCOM, INC. (IFCI) to Issuer (Check all applicable) - -------------------------------------------------------------------------------------------- x Director 10% Owner (Last) (First) (Middle) 3. IRS Identification 4. Statement for ---- --- Number of Reporting Month/Year Officer (give Other (specify 101 Wild Oak Court Person, if an entity December 31, 2000 ---- title --- below) - ------------------------------------------- (voluntary) ------------------- below) (Street) 5. If Amendment, 7. Individual or Joint/Group Reporting Date of Original (check applicable line) (Month/Year) x Form Filed by One Reporting Person Danville California 94506 -- ---- Form Filed by More than One reporting Person - ------------------------------------------- ------------------------------------------------------------------------------------- (City) (State) (Zip) 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. 8) End of Issuer's Direct Benefi- (Month/ 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, no par value 10/13/00 M 150,000 A $6.00 202,293 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, no par value 1,950 I by Children - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ * If the form is filed by more than one reporting person, see instruction 4(b)(v). (Over) SEC 2270 (7/96)
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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 Ac- Expiration Securities Deriv- Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative Deriv- Day/ Disposed of (D) (Month/Day/ Secur- ative Year) (Instr. 3, 4, Year) ity Security and 5) (Instr. 5) ----------------------------------- Date Expira- Amount or --------------- Exer- tion Title Number of (A) (D) cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ Options Common (Right to Buy) $7.625 1/05/00 A 10,000 1/05/00 1/04/05 Stock 10,000 - ------------------------------------------------------------------------------------------------------------------------------------ Options Common (Right to Buy) $14.31 5/31/00 A 10,000 5/31/00 5/31/05 Stock 10,000 - ------------------------------------------------------------------------------------------------------------------------------------ Options Common (Right to Buy) $6.00 10/13/00 M 150,000 5/20/99 5/19/04 Stock 150,000 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------- 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 month (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------- 10,000 D - ------------------------------------------------------------------------------------------------------- 10,000 D - ------------------------------------------------------------------------------------------------------- -0- D - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- Explanation of Responses: /s/ C. James Jensen Feb. 14, 2001 ------------------------------- ------------- **Signature of Reporting Person 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. 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.
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