U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 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
================================================================================
1. Name and Address of Reporting Person*
HANNESSON PAUL E.
- --------------------------------------------------------------------------------
(Last) (First) (Middle)
c/o Commodore Separation Technologies, Inc.
150 East 58th Street, Suite 3400
- --------------------------------------------------------------------------------
(Street)
New York New York 10155
- --------------------------------------------------------------------------------
(City) (State) (Zip)
================================================================================
2. Issuer Name and Ticker or Trading Symbol
COMMODORE SEPARATION TECHNOLOGIES, INC.
("CXOT")
================================================================================
3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
================================================================================
4. Statement for Month/Year
December 31, 1998
================================================================================
5. If Amendment, Date of Original (Month/Year)
================================================================================
6. Relationship of Reporting Person to Issuer
(Check all applicable)
|X| Director | | 10% Owner
|X| Officer (give title below) | | Other (specify below)
Chairman and Chief Executive Officer
================================================================================
7. Individual or Joint/Group Filing (Check Applicable Line)
|X| Form filed by One Reporting Person
| | Form filed by More than One Reporting Person
================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
<PAGE>
================================================================================
Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
================================================================================
<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) and 4) (Instr.4) (Instr. 4)
- ------------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly
<PAGE>
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially
Owned (e.g., puts, calls, warrants, options, convertible securities)
================================================================================
<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)
- ------------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Employee Stock $5.00 12/15/98 D 135,000 (1) 9/5/06 Common 135,000 $5.00 -0- D
Option Stock
(right to buy)
- ------------------------------------------------------------------------------------------------------------------------------------
Employee Stock $2.50 12/15/98 D 40,000 (2) 6/17/07 Common 40,000 $2.50 -0- D
Option Stock
(right to buy)
- ------------------------------------------------------------------------------------------------------------------------------------
Employee Stock $0.09375 12/15/98 A 280,000 (3) 12/15/08 Common 280,000 $0.09375 280,000 D
Option Stock
(right to buy)
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
</TABLE>
Explanation of Responses:
(1) Options were vested 60% on 9/5/98; 20% would vest on 9/5/99 and 20% on
9/5/00.
(2) Options were vested 40% on 6/17/98; 20% would vest on 6/17/99, 20% on
6/17/00 and 20% on 6/17/01.
(3) Options vested 50% on 12/15/98 and will vest 50% on 12/15/99.
/s/ Paul E. Hannesson February 12, 1999
- --------------------------------------------- -----------------------
**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.
