U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
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
[ ] Check box if no longer
subject to Section 16.
Form 4 or Form 5 obligations
may continue. See Instruction 1(b)
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1. Name and Address of Reporting Person*
Niedzielski Vince
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(Last) (First) (Middle)
6450 Via Real
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(Street)
Carpinteria California 93013
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
QAD, Inc. QADI
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3. IRS Identification Number of Reporting Person,if an Entity (Voluntary)
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4. Statement for Month/Year
01/00
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [ ] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
Executive Vice President - Production
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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>
<CAPTION>Table I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
<S> <C> <C> <C> <C> <C> <C>
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1. Title of Security 2. Transaction 3.Transaction 4. Securities Acquired(A) 5. Amount of 6. Ownership 7. Nature
(Instr. 3) Date Code or Disposed of (D) Securities Form: of
(Month/Date/ (Instr.8) (Instr. 3,4 and 5) Beneficially Direct(D) Indirect
Year) A Owned at End or Beneficially
or of Year Indirect(I) Ownership
Amount D Price (Instr. 3 and 4) (Instr. 4) (Instr. 4)
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</TABLE>
* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
<PAGE>
Form 5 (continued)
<TABLE>
<CAPTION> Table II (PART 1) Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities) (Columns 1 through 6)
<S> <C> <C> <C> <C> <C> <C>
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1. Title of Derivative 2. Conversion 3. Transaction 4.Transaction 5. Number of Derivative 6. Date Exercisable and
Security or Exercise Date Code Securities Acquired (A) Expiration Date
(Instr. 3) Price of (Month/Day/ (Instr. 8) or Disposed of (D) (Month/Date/Year)
Derivative Year) (Instr. 3,4 and 5) Date Expiration
Security A D Exercisable Date
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Stock Option $3.50 3/11/99 A 3,500 * 3/11/03
Stock Option $3.8125 9/15/99 A 40,000 ** 9/15/03
Stock Option $3.5313 10/07/99 A 100 *** 10/07/03
</TABLE>
<TABLE>
<CAPTION> Table II (PART 2) Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities) (Columns 1,3 and 7 through 11)
<S> <C> <C> <C> <C> <C> <C>
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1. Title of 3. Transaction 7. Title and Amount 8. Price 9. Number of 10. Ownership Form of 11. Nature of
Derivative Date of Underlying of Derivative Derivative Derivative Indirect
Security (Month/Day/Year) Securities Security Securities Security: Beneficial
(Instr. 3) (Instr. 3 and 4) (Instr. 5) Beneficially Direct (D) or Ownership
Amount or Number Owned at End of Indirect (I) (Instr. 4)
Title of Shares Year (Instr. 4) (Instr. 4)
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Stock Option 3/11/99 Common Stock 3,500 N/A 3,500 D
Stock Option 9/15/99 Common Stock 40,000 N/A 40,000 D
Stock Option 10/07/99 Common Stock 100 N/A 100 D
</TABLE>
Explanation of Responses:
* Vests 875 shares annually beginning 3/11/00, 3/11/01, 3/11/02 and 3/11/03
** Vests 10,000 shares annually beginning 9/15/00, 9/15/01, 9/15,02 and 9/15/03
*** Vests 25 shares annually beginning 10/07/00, 10/07/01, 10/07/02 and 10/07/03
/s/ Vince Niedzielski March 16, 2000
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**Signature of Reporting Person Date
**International 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.
2
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