5 1 d5.txt FORM 5 FOR WINGATE 12/31/2001 ================================================================================ /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number: 3235-0362 / / Expires: January 31, 2005 / / Estimated average burden / / hours per response...... 1.0 / /------------------------------/ +--------+ UNITED STATES | FORM 5 | SECURITIES AND EXCHANGE COMMISSION +--------+ Washington, D.C. 20549 [_] Check box if no longer subject ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP to Section 16. Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities obligations may Exchange Act of 1934, Section 17(a) of the continue. See Public Utility Holding Company Act of 1935 or Instruction 1(b). Section 30(f) of the Investment Company Act of 1940 [_] Form 3 Holdings Reported [_] Form 4 Transactions Reported -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* WINGATE GORDON R. ---------------------------------------------------------------------------- (Last) (First) (Middle) 600 Century Plaza Drive, Suite 140 ---------------------------------------------------------------------------- (Street) Houston TX 77073-6014 ---------------------------------------------------------------------------- (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol Industrial Data Systems Corporation (AMEX: IDS) ----------------------------------- 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) -------------- 4. Statement for Month/Year December 2001 --------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) -------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) X ___ Director Officer ____ 10% Owner ____ Other (give title below) (specify below) Former director of Issuer -- see note 3 7. Individual or Joint/Group Reporting (check applicable line) X ___ Form Filed by One Reporting Person ___ Form Filed by More than One Reporting Person ------------------------------------------------------------------------------- Table I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature (Instr. 3) action action or Disposed of (D) Securities ship of In- Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Month/ (Instr. 8) Owned at the Direct Bene- Day/ end of (D) or ficial Year) Issuer's Indirect Owner- (A) or Fiscal Year (I) ship Amount (D) Price (Instr. 3 and 4) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------- 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. Transac- 5. Number of Deriv- Security (Instr. 3) sion or action tion Code ative Securities Exercise Date (Instr. 8) Acquired (A) or Price of (Month/ Disposed of (D) Deriv- Day/ (Instr. 3, 4, and 5) ative Year) Security --------------------------- (A) (D) ----------------------------------------------------------------------------------------------------------------------------- Common Stock $1.00 12/1/01 L/A A ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------ 6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na- cisable and Underlying Securities of of Deriv- ship ture Expiration (Instr. 3 and 4) Deriv- ative of De- of In- Date ative Secur- rivative direct (Month/Day/ Secur- ities Secu- Bene- Year) ity Bene- rity: ficial (Instr. 5) ficially Direct Owner- -------------------------------------------- Owned (D) or ship Date Expira- Amount or at End Indi- (Instr. 4) Exer- tion Title Number of of Year rect (1) cisable Date Shares (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Note 1 12/1/11 Note 2 5,000 N/A 20,000 D N/A ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
* If the form is filed by more than one reporting person, see instruction 4(b)(v). Explanation of Responses: NOTE 1. Gradual Vesting, fully exercisable 12/31/2005 NOTE 2. Option, giving right to buy /s/ Gordon R. Wingate February 13, 2002 -------------------------------- ----------------- **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.