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OMB APPROVAL
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OMB Number 3235-0362
Expires: April 30, 1997
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 this box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
[ ] Form 3 Holdings Reported
[x ] Form 4 Transactions Reported
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1. Name and Address of Reporting Person
Celani Thomas
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(Last) (First) (Middle)
1741 Heron Ridge Drive
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(Street)
Bloomfield Hills MI 48302
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Sodak Gaming, Inc. (SODK)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
December 1998
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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 [ x ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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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-
Security 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 $.001 par value 3,114,000 D
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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 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>
Stock Option 10.875 J(6) 2,000 (1) Common 2,000 0 D
(right to buy) 12/30/93 6/30/98 Stock
$.001 par value
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Stock Option 8.25 (1) Common 2,000 2,000 D
(right to buy) 11/21/94 5/12/99 Stock
$.001 par value
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Stock Option 7.00 (2) Common 10,000 10,000 D
(right to buy) 11/12/95 5/12/00 Stock
$.001 par value
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Stock Option 12.875 (3) Common 10,000 10,000 D
(right to buy) 10/30/96 4/30/01 Stock
$.001 par value
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Stock Option 12.00 5/6/97 10,000 (4) Common 10,000 10,000 D
(right to buy) 11/06/97 5/06/02 Stock
$.001 par value
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Stock Option 6.4375 5/7/98 10,000 (5) Common 10,000 10,000 D
(right to buy) 11/07/98 5/07/03 Stock
$.001 par value
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</TABLE>
Explanation of Responses:
1. Grant to reporting person of option to buy 2,000 shares of common stock
under Sodak Gaming, Inc. 1993 Non-employee Director Option Plan in
transaction exempt under Rule 16b-3. This option was previously
reported as covering 1000 shares, but was adjusted to reflect a stock
split on September 27, 1996.
2. Grant to reporting person of option to buy 10,000 shares of common stock
under Sodak Gaming, Inc. 1993 Non-employee Director Option Plan in
transaction exempt under Rule 16b-3. This option was previously
reported as covering 5000 shares, but was adjusted to reflect a stock
split on September 27, 1996.
3. Grant to reporting person of option to buy 10,000 shares of common stock
under Sodak Gaming, Inc. 1993 Non-employee Director Option Plan in
transaction exempt under Rule 16b-3. This option was previously
reported as covering 5000 shares, but was adjusted to reflect a stock
split on September 27, 1996.
4. Grant to reporting person of option to buy 10,000 shares of common stock
under Sodak Gaming, Inc. 1993 Non-employee Director Option Plan in
transaction exempt under Rule 16b-3.
5. Grant to reporting person of option to buy 10,000 shares of common stock
under Sodak Gaming, Inc. 1993 Non-employee Director Option Plan in
transaction exempt under Rule 16b-3.
6. Expiration of options in accordance with its terms.
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**Signature of Reporting Person Date
** 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 procedure.
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