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Previous: INTERMAGNETICS GENERAL CORP, 10-Q, 1998-10-14 |
Next: HEI INC, 5, 1998-10-14 |
FORM 5
/ / Check box if no longer subject to Section 16. Form 4 or
Form 5 obligations may continue. See Instruction 1(b)
/ / 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
<TABLE>
<S> <C> <C>
1. Name and Address of Reporting Person 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer
HEI, Inc. (HEII) (Check all applicable)
Zimmerman Frederick 3. IRS or Social Security 4. Statement for X Director 10% Owner
(Last) (First) (Middle) Number of Reporting Month/Year --- --
Person (Voluntary) August 1998 Officer (give ____ Other (specify
--- title below) below)
14860 Lloyd's Drive
(Street)
Minnetonka MN 55345
(City) (State) (Zip)
5. If Amendment, 7. Individual or Joint/Group Filing (Check Applicable
Date of Original Line)
(Month/Year)
X Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
</TABLE>
TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF,
OR BENEFICIALLY OWNED
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
1. Title of 2. Transaction Date 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature
Security (Month/Day/ Code or Disposed of (D) Securities Form: of
(Instr. 3) Year) (Instr. 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Indirect
Owned at or Indirect Beneficial
Issuer's (I)(Instr. 4) Ownership
Fiscal Year (Instr. 4)
(Instr. 3 and 4)
Amount (A) or (D) Price
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</TABLE>
*If the form is filed by more than reporting person, see Instruction 4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
<PAGE>
TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<TABLE>
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
1. Title of 2.Conver- 3. Trans- 4. Transac- 5. Number of 6. Date Exer- 7. Title and 8. Price 9. Number 10. Owner- 11. Na-
Derivative sion or action tion Deriva- cisable Amount of of of ship ture
Security Exercise Date Code tive Secur- and Expira- Underlying Deriv- Deriv- Form of In-
(Instr. 3) Price of Month/ (Instr. 8) ities Ac- tion Date Securities ative ative of direct
of Deriv- Day/ quired (A) (Month/Day/ (Instr. 3&4) Secur- Secur- De- Bene-
ative Year) or Disposed Year) ity ities rivative ficial
Security of (D) (Instr. Bene- Secu- Owner-
Instr. 5) ficially rity: ship
3,4, and 5) Owned at Direct (Instr.
End of (D) or 4)
Month Indirect
(Instr. (I)
4) (Instr.
4)
Date Expira-
Exer- tion Amount or
cisable Date Title Number of
Shares
(A) (D)
Stock Options 4.7125 8/28/98 J(1) 10,000 1/19/96 1/19/05 Common 10,000 9.00 0
Stock
$.05
par
value
Stock Options 6.0000 8/28/98 J(1) 10,000 1/18/97 1/18/06 Common 10,000 9.00 0
Stock
$.05
par
value
Stock Options 11.3250 8/28/98 J(1) 10,000 1/23/98 1/23/07 Common 10,000 9.00 0
Stock
$.05
par
value
Stock Options 4.9250 8/28/98 J(1) 10,000 1/22/99 1/22/08 Common 10,000 9.00 0
Stock
$.05
par
value
Explanation of Responses:
(1) Pursuant to the Company's Employee Stock Option Plan, all options held by the reporting person granted under the plan became
fully vested and exercisable upon the change of control which occurred in August 1998 and such options were cashed out on the basis
of the change of control price (as determined under the plan). Upon such payment, all such options were cancelled.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/Frederick Zimmerman October 13, 1998
--------------------- ----------------
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date
Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient,
see Instruction 6 for procedure. Page 2
</TABLE>
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