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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 this 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
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1. Name and Address of Reporting Person
Simons, James H.
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(Last) (First) (Middle)
c/o Renaissance Technologies Corp. 800 Third Avenue
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(Street)
New York, NY 10022
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Segue Software, Inc. (SEGU)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
December, 1996
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5. If Amendment, Date of Original (Month/Year)
N/A
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [ ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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<TABLE>
<CAPTION>
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
Disposed of (D) Beneficially Form: 7.
(Instr. 3, 4 and 5) Owned at End Direct Nature of
2. 3. ----------------------------- of Issuer's (D) or Indirect
1. Transaction Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (Instr. 8) (D) & 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock 4/1/96 C(1) 35,000 A 1-for-1 101,666 D
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Common Stock 12/31/96 C(2) 120,000 A 1-for-1 706,973 I (3)
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
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FORM 5 (continued)
<TABLE>
<CAPTION>
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Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Employee Stock
Option $22.25 4/2/96 A 4,000 (4) 4/2/2006 Common 4,000 14,000
(right to buy) Stock
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Employee Stock
Option $1.00 11/1/88 A 10,000 11/1/92(5) 10/31/98 Common 10,000 14,000
(right to buy) Stock
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Series A
Convertible 1-for-1 4/1/96 C 35,000 4/1/96(1) 4/1/96(1) Common 35,000 0
Preferred Stock Stock
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Explanation of Responses:
(1) The shares converted automatically into shares of common stock as of the
closing of the initial public offering.
(2) Converted automatically as of 12/31/96.
(3) These shares are held by the Bermuda Trust Company Limited, as trustee of
the Lord Jim Trust, a trust created under the laws of Bermuda (the
"Trust"). The principal beneficiaries of the Trust are Dr. Simons, his
parents and his children.
(4) The option vests in three installments: 2,000 shares of Common Stock will
vest after six months and 1,000 shares every three months thereafter.
(5) The options vested in four equal annual installments beginning on 11/1/88.
/s/ James H. Simons 2/14/97
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**Signature of Reporting Person Date
James H. Simons
** Intentional misstatements or omissions of facts constitute Federal Criminal
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
