FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
Washington, D.C. 20549 OMB Number
[ ] Check this box if Expires:
no longer subject Estimated ave.
to Section 16. burden
Form 4 or Form 5 hours per response
obligations may ----------------
continue. See
instruction 1(b)
[ ] Form 3 Holdings
Reported
[X] Form 4 Filed pursuant to Section 16(a) of the Securities
Trans- Exchange Act of 1934, Section 17(a) of the Public
actions Utility Holding Company Act of 1935 or
Reported Section 30(f) of the Investment Company Act 1940
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1. Name and Address of 2. Issuer Name and 6. Relationship of Reporting
Reporting Person* Ticker or Trading Person to Issuer (check
Symbol all Applicable)
X Director 10% Owner
Kartsotis Tom Fossil, Inc. (FOSL) --- ---
- ------------------------- ---------------------- X Officer Other
(Last) (First) (MI) --- ---
(Give title (specify below)
2280 N. Greenville Ave below)
- -------------------------
January 2000
(Street ---------------------- ----------------------------
Richardson, TX 75082 3. IRS or Soc. Sec. No. 4. Statement for Month/
- ------------------------- of Reporting Person Year
(City) (State) (Zip) (Voluntary)
---------------------- ----------------------------
5. If Amendment, Date of 7. Individual or Joint/Group
Original (Month/Year) Filing (Check Applicable
Line)
X Form filed by One
--- Reporting Person
Form filed by More
--- than One Reporting
Person
<TABLE>
<CAPTION>
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Table I - Non-Derivative Securities Acquired, Disposed of or Beneficially Owned
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<S> <C> <C> <C>
1. Title of Security 2. Transaction 3. Transaction 4. Security Acquired (A)
(Inst.3) Date Code or Disposed of (D)
(Month/ (Instr.8) (Inst.3, 4 & 5)
Day/Yr) ----------------------------------------
(A)
Code V Amount (D) Price
Common Stock,
par value $0.01 9/30/99 M 49,500 A $3.3334
- ------------------------ ------------- ------ ----- ------------- --- -------
Common Stock,
par value $0.01 9/30/99 M 11,250 A $6.8889
- ------------------------ ------------- ------ ----- ------------- --- -------
- ------------------------ ------------- ------ ----- ------------- --- -------
- ------------------------ ------------- ------ ----- ------------- --- -------
- ------------------------ ------------- ------ ----- ------------- --- -------
- ------------------------ ------------- ------ ----- ------------- --- -------
<PAGE>
<CAPTION>
<S> <C> <C>
5. Amount of Securities 6. Ownership Form 7. Nature of Indirect
Beneficially Owned at Direct (D) or Beneficial Ownership
at End of Month Indirect (I) (Inst. 4)
(Inst. 3 & 4)
I
- ------------------------ ----------------------------- -------------------------
1,205,583 I (1)
- ------------------------ ----------------------------- -------------------------
9,010,867 D
- ------------------------ ----------------------------- -------------------------
- ------------------------ ----------------------------- -------------------------
- ------------------------ ----------------------------- -------------------------
Reminder: Report on a separate line for each class securities owned directly or
indirectly.
*If the form is filed by more than one reporting person, see Instruction 4(b)(v)
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
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Table II - Derivative Securities Acquired, Disposed of,
Beneficially Owned (e.g., puts, calls, warrants,
options, convertible security)
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<S> <C> <C> <C>
1. Title of 2. Conversion 3. Transaction 4. Transaction
Derivative or Exercise Date (Month Code
Security Price of (Day/Year) (Instr. 8)
(Instr.3) Derivative
Security Code V
Incentive Stock
Option $3.3334 9/30/99 M
- ------------------- -------------------- --------------------- --------------
Incentive Stock
Option $6.8889 9/30/99 M
- ------------------- -------------------- --------------------- --------------
- ------------------- -------------------- --------------------- --------------
- ------------------- -------------------- --------------------- --------------
- ------------------- -------------------- --------------------- --------------
<CAPTION>
<S> <C> <C>
5. Number of Derivative 6. Date Exercisable 7. Title & Amount of
Securities Acquired & Expiration Date Underlying Securities
(A) or Disposed of (D) (Mon./Day/Year) (Inst. 3 & 4)
(Instr. 3, 4 & 5)
- --------------------------------------------------------------------------------
(A) (D) Date Expiration Title Amount or
Exercisable Date number of
Shares
Common
49,500 Stock 49,500
- ------------ ------------ ----------- ----------- -------- ------------
Common
11,250 Stock 11,250
- ------------ ------------ ----------- ----------- -------- ------------
- ------------ ------------ ----------- ----------- -------- ------------
- ------------ ------------ ----------- ----------- -------- ------------
<CAPTION>
<C> <C> <C> <C>
8. Price of Derviative 9. Number of Derivative Securities 10. Ownership Form of 11. Nature of Indirect
Security (Inst.5) Beneficially Owned at end of Derivative Security Beneficial
Month (Instr. 4) Dir. (D) or Ind. (I) Ownership (Instr.4)
0 I
- ---------------------- --------------------------------- ----------------------- -----------------------
0 I
- ---------------------- --------------------------------- ----------------------- -----------------------
- ---------------------- --------------------------------- ----------------------- -----------------------
- ---------------------- --------------------------------- ----------------------- -----------------------
- ---------------------- --------------------------------- ----------------------- -----------------------
- ---------------------- --------------------------------- ----------------------- -----------------------
</TABLE>
<PAGE>
Explination of Responses
(1) Includes 1,190,925 shares owned by Lynne Kartsotis, wife of Tom Kartsotis
and 12,658 shares owned by Mr. Kartsotis for Annie Grace Kartsotis
<TABLE>
<CAPTION>
<S> <C>
**Intentional misstatements or omissions of facts constitute Federal /s/ Tom Kartsotis 3/20/00
Crimminal Violations. 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.
Potential persons who are to respond to the collections of information contained
in this form are not required to respond unless the form displays a currently
valid OMD Number.
</TABLE>
