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FORM 5
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/ / CHECK BOX IF NO U.S. SECURITIES AND EXCHANGE COMMISSION
LONGER SUBJECT TO WASHINGTON, DC 20549
SECTION 16. FORM
4 OR FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
OBLIGATIONS MAY
CONTINUE. SEE Filed pursuant to Section 16(a) of the Securities
INSTRUCTION 1(b) Exchange Act of 1934,
/ / FORM 3 HOLDINGS Section 17(a) of the Public Utility
REPORTED Holding Company Act of 1935 or Section 30(f) of
/ / FORM 4 the Investment Company Act
TRANSACTIONS of 1940
REPORTED
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<S> <C> <C> <C> <C> <C> <C>
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Vaisman Gideon Kellstrom Industries, Inc. (KELL) Issuer (Check all applicable)
- ------------------------------------------- ---------------------------------------------- Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
Number of Reporting Month/Year X Officer (give Other (specify
22 Woodland Drive Person, if an Entity 12/98 ---- title --- below)
- ------------------------------------------- (Voluntary) ------------------- below)
(Street) 5. If Amendment, Senior Vice President
Tenafly NJ 07670 Date of Original -------------------------------
- ------------------------------------------- (Month/Year)
(City) (State) (Zip) 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 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. End of Issuer's Direct Benefi-
(Month/ 8) Fiscal Year (D) or cial
Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner-
Year) Amount (A) or (D) Price (I) ship
(Instr. 4) (Instr.
4)
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*If the form is filed by more than one Reporting Person, see Instruction 4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
(Print or Type Responses)
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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)
<S> <C> <C> <C> <C> <C> <C> <C>
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Expiration Securities Deriv-
Price of (Month/ (Instr. Acquired (A) Date (Instr. 3 and 4) ative
Deriv- Day/ 8) or Disposed (Month/Day/ Secur-
ative Year) of (D) Year) ity
Security (Instr. 3, (Instr. 5)
4, and 5) ----------------- ---------------------
Date Expira- Amount or
------------- Exer- tion Title Number of
(A) (D) cisable Date Shares
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Employee Stock Options $24.00/sh. 04/01/98 A 150,000 -- (1) 04/01/08 Common Stock 150,000 --
(Right to buy)
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Employee Stock Options $10.125/sh. 10/08/98 A 50,000 -- (2) 10/08/08 Common Stock 50,000 --
(Right to buy)
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Employee Stock Options $24.00/sh. 10/08/98 D -- 50,000 (3) 04/01/08 Common Stock 50,000 --
(Right to buy)
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<C> <C> <C> <C>
1. Title of Derivative 9. Number of 10. Ownership 11. Nature of
Security Derivative of Derivative Indirect
(Instr. 3) Securities Security: Beneficial
Beneficially Direct (D) Ownership
Owned at End or Indirect (I) (Instr. 4)
of Year (Instr. 4)
(Instr. 4)
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Employee Stock Options 100,000 D N/A
(Right to buy)
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Employee Stock Options 50,000 D N/A
(Right to buy)
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Employee Stock Options 0 D N/A
(Right to buy)
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Explanation of Responses:
(1) These Employee Stock Options vest in three equal installments on 04/01/99,
04/01/00 and 04/01/01.
(2) These Employee Stock Options vest in three equal installments on 10/01/99,
04/01/01 and 10/01/02.
(3) These Employee Stock Options vest in three equal installments on 04/01/99,
04/01/00 and 04/01/01.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Gideon Vaisman 2/12/99
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- -------
**Signature of Reporting Person Date
Gideon Vaisman
Note. File three copies of this form, one of which must be manually signed. Page 2
If space provided is insufficient, see Instruction 6 for procedure.
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