FORM 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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
(Print or Type Responses)
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1. Name and Address of Reporting Person
Horner Derrick L.
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(Last) (First) (Middle)
c/o Source Media, Inc., 5400 LBJ Freeway, Suite 680
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(Street)
Dallas TX 75240
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
11/06/2000
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Source Media, Inc. (SRCM)
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5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
[ ] Director [ ] 10% Owner
[ X ] Officer (give title below) [ ] Other (specify below)
Vice President and General Counsel
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6. If Amendment, Date of Original (Month/Day/Year)
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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>
<CAPTION>
TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
1. Title of Security Beneficially Owned Direct (D) or Beneficial
(Instr. 4) (Instr. 4) Indirect (I) (Instr. 5) Ownership (Instr. 5)
<S> <C> <C> <C>
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</TABLE>
* Reminder: Report on a separate line for each class of securities
beneficially owned directly or indirectly.
If the form is filed by more than one reporting person, see Instruction 5(b)(v)
<PAGE>
Form 3 (continued)
<TABLE>
<CAPTION>
TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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5. Ownership
Form of
Derivative 6. Nature of
1. Title of 2. Date 3. Title and Amount of 4. Conversion or Security: Indirect
Derivative Exercisable and Securities Underlying Exercise Price Direct (D) Beneficial
Security Expiration Date Derivative Security of Derivation Indirect (I) Ownership
(Instr. 4) (Month/Day/ Year) (Instr. 4) Security (Instr. 5) (Instr. 5)
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Date Expiration Title Amount or
Exercisable Date Number of
Shares
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<S> <C> <C> <C> <C> <C> <C> <C>
Employee Stock
Option (Right to Buy) (1) 11/06/2010 Common Stock 150,000 $3.141 D
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</TABLE>
Explanation of Responses: (1) The option vests in four equal annual installments
beginning on November 6, 2001.
By: /s/ Derrick L. Horner 11/13/2000
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**Signature of Reporting Person Date
Derrick L. Horner
** Intentional 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 procedures.
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 current
valid OMB Number.
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