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OMB APPROVAL
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OMB Number 3235-0362
Expires: December 31, 2001
Estimated average burden
hours per response ....... 1.0
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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 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*
Febish George J.
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(Last) (First) (Middle)
ObjectSoft Corporation
Continental Plaza, Building III
433 Hackensack Avenue
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(Street)
Hackensack NJ 07601
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
ObjectSoft - OSFT
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
12/99
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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)
[X] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
President, Co-Chief Executive Officer and Treasurer
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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
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
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) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock, par value
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$.0001 per share (1) 134,583(2) D
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</TABLE>
* If the form is filed by more than one Reporting Person, see Instruction
4(b)(v).
(Over)
SEC 2270 (3-99)
<PAGE>
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
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>
Option to Purchase Imme- Common
Common Stock $8.70 8,333 diately 6/30/01 Stock 8,333 D
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Option to Purchase Imme- Common
Common Stock $8.70 8,333 diately 7/08/03 Stock 8,333 D
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Option to Purchase Common
Common Stock $13.50 2/26/99 A 8,333 (3) 2/25/04 Stock 8,333 D
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Option to Purchase Common
Common Stock $1.50 12/09/99 A 23,333 (4) 12/08/04 Stock 23,333 D
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Performance Option
to Purchase Common
Common Stock $1.50 12/09/99 A 500,000 (5) 12/08/04 Stock 500,000 D
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Warrant to Purchase Common
Common Stock $3.00 8,333 4/15/93 4/30/00 Stock 8,333 556,665 D
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</TABLE>
Explanation of Responses:
(1) On October 13, 1999, ObjectSoft Corporation effected a one-for-six reverse
split (the "Stock Split") of its outstanding shares of common stock. All
references to shares of common stock and exercise prices of options and
warrants take into account the Stock Split.
(2) Includes 25,000 shares of common stock owned by The George J. Febish Family
Trust of which Mr. Febish's wife and Melvin Weinberg are the trustees and
as to which shares Mr. Febish disclaims beneficial ownership.
(3) The option is exercisable as to 4,167 shares of common stock as of February
26, 1999 and 4,166 shares of common stock as of February 26, 2000.
(4) The option is exercisable as to 11,667 shares of common stock as of
December 9, 1999 and 11,666 shares of common stock as of December 9, 2000.
(5) The performance option is exercisable, in tranches, upon achievement of
certain performance goals. If any performance goal is not achieved by
December 9, 2002, the portion of the option relating to that performance
goal will expire. 50,000 shares of common stock are exercisable as of
December 30, 1999.
** Intentional misstatements or omissions of facts constitute Federal Criminal
Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
/s/ George J. Febish February 10, 2000
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**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 collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB number. Page 2
SEC 2270 (3-99)
