-----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, V08pbPmFKlHgJefkRo8+iGBTBnWt8pWcP2DvqMqG+Zg6kefmFrDm/NgTi8zucfH7 Nbrf5WVnJMePFxx3WU+q0w== 0000889812-97-000415.txt : 19970222 0000889812-97-000415.hdr.sgml : 19970222 ACCESSION NUMBER: 0000889812-97-000415 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19961231 FILED AS OF DATE: 19970214 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FINANCIAL SERVICES ACQUISITION CORP /DE/ CENTRAL INDEX KEY: 0000931707 STANDARD INDUSTRIAL CLASSIFICATION: LOAN BROKERS [6163] IRS NUMBER: 593262958 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25056 FILM NUMBER: 97532526 BUSINESS ADDRESS: STREET 1: 667 MADISON AVE CITY: NEW YORK STATE: NY ZIP: 10021 BUSINESS PHONE: 2122461000 MAIL ADDRESS: STREET 1: 667 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10021 COMPANY DATA: COMPANY CONFORMED NAME: KOPP LARRY S CENTRAL INDEX KEY: 0001022194 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: PO BOX 1616 CITY: TACOMA STATE: WA ZIP: 98402 5 1 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP FORM 5 / / Check box if no longer OMB APPROVAL subject to Section 16. OMB NUMBER: 3235-0362 Form 4 or Form 5 EXPIRES: SEPTEMBER 30, 1998 obligations may continue. ESTIMATED AVERAGE BURDEN See Instruction 1(b) HOURS PER RESPONSE 1.0 / / Form 3 Holdings Reported / / Form 4 Transactions Reported 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* Kopp Larry S. (Last) (First) (Middle) 2023 Narrows View Circle, B-212 (Street) Gig Harbor Washington 98335 (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol Financial Services Acquisition Corporation (Common Stock: "FSAT"; Series A Warrants: "FSATW") 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year 12/96 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( X ) Director ( ) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 7. Individual or Joint/Group Filing (Check applicable line) ( X ) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person * If Form is filed by more than one Reporting Person, see Instruction 4(b)(v). (Print or Type Responses) Page 1
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1. Title of Security 2. Transaction Date 3. Transaction Code 4. Securities Acquired (A) or (Instr. 3) (Month/Day/Year) (Instr. 8) Disposed of (D) (Instr. 3, 4 and 5) ------------------------------------------- Amount (A) or (D) Price - ------------------------------------- ----------------------- -------------------- ------------- ------------- ------------- a. Common Stock, par value $.001 - ------------------------------------- ----------------------- -------------------- ------------- ------------- ------------- b. - ------------------------------------- ----------------------- -------------------- ------------- ------------- ------------- c. - ------------------------------------- ----------------------- -------------------- ------------- ------------- ------------- d. - ------------------------------------- ----------------------- -------------------- ------------- ------------- ------------- e. - ------------------------------------- ----------------------- -------------------- ------------- ------------- ------------- f. - ------------------------------------- ----------------------- -------------------- ------------- ------------- ------------- 5. Amount of Securities Beneficially 6. Ownership Form: 7. Nature of Indirect Owned at End of Issuer's Fiscal Year Direct (D) or Indirect (I) Beneficial Ownership (Instr. 3 and 4) (Instr. 4) (Instr. 4) - ------------------------------------------ ---------------------------------- ---------------------------------- a. 33,000 D - ------------------------------------------ ---------------------------------- ---------------------------------- b. - ------------------------------------------ ---------------------------------- ---------------------------------- c. - ------------------------------------------ ---------------------------------- ---------------------------------- d. - ------------------------------------------ ---------------------------------- ---------------------------------- e. - ------------------------------------------ ---------------------------------- ---------------------------------- f. - ------------------------------------------ ---------------------------------- ---------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g, puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security 2. Conversion or 3. Transaction Date 4. Transaction 5. Number of Derivative Securities (Instr. 3) Exercise Price (Month/Day/Year) Code Acquired (A) or Disposed of (D) of Derivative (Instr. 8) (Instr. 3, 4 and 5) Security ---------------------------------- (A) (D) - --------------------------------- ----------------- -------------------- --------------- ----------------- ---------------- a. Series A Redeemable Common $5.00 Stock Purchase Warrants - --------------------------------- ----------------- -------------------- --------------- ----------------- ---------------- b. Options - Right to Buy $5.00 (1) A 10,000 - --------------------------------- ----------------- -------------------- --------------- ----------------- ---------------- c. - --------------------------------- ----------------- -------------------- --------------- ----------------- ---------------- d. - --------------------------------- ----------------- -------------------- --------------- ----------------- ---------------- e. - --------------------------------- ----------------- -------------------- --------------- ----------------- ---------------- f. - --------------------------------- ----------------- -------------------- --------------- ----------------- ---------------- 6. Date Exercisable 7. Title and Amount of Underlying 8. Price of 9. Number of 10. Ownership 11. Nature of and Expiration Securities Derivative Derivative Form of Indirect Date (Instr. 3 and 4) Security Securities Derivative Beneficial (Month/Day/Year) (Instr. 5) Beneficially Security: Ownership - --------------------------- --------------------------------- Owned at Direct (D) (Instr. 4) Date Expiration Title Amount or End of Year or Indirect Exercisable Date Number of (Instr. 4) (I) Shares - --------------- ----------- ----------------- -------------- -------------- -------------- --------------- -------------- a. Immediate 11/30/01 Common Stock 21,000 21,000 D - --------------- ----------- ----------------- -------------- -------------- -------------- --------------- -------------- b. (1) 08/26/06 Common Stock 10,000 10,000 D - --------------- ----------- ----------------- -------------- -------------- -------------- --------------- -------------- c. - --------------- ----------- ----------------- -------------- -------------- -------------- --------------- -------------- d. - --------------- ----------- ----------------- -------------- -------------- -------------- --------------- -------------- e. - --------------- ----------- ----------------- -------------- -------------- -------------- --------------- -------------- f. - --------------- ----------- ----------------- -------------- -------------- -------------- --------------- --------------
Explanation of Responses: (1) Options were all granted on August 27, 1996 under the issuer's 1996 stock option plan and have 10 year terms (unless the reporting person's service as a director of the issuer terminates earlier). 50% of the options become exercisable 6 months from the date of grant and 50% of the options become exercisable 1 year from the date of grant. /s/ Larry S. Kopp February 14, 1997 - --------------------------------- ---------------------- ** 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. (Print or Type Responses) Page 3 -----END PRIVACY-ENHANCED MESSAGE-----