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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
Stern Yoav Kellstrom Industries, Inc. (KELL) Issuer (Check all applicable)
- ------------------------------------------- ---------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS Identification 4. Statement for ---- ---
98 Battery Stret Number of Reporting Month/Year Officer (give Other (specify
- ------------------------------------------- Person, if an Entity 12/98 ---- title --- below)
(Street) (Voluntary) ------------------- below)
San Francisco CA 94111 5. If Amendment,
- ------------------------------------------- Date of Original -------------------------------
(City) (State) (Zip) (Month/Year)
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 Price (I) ship
(D) (Instr. 4) (Instr.
4)
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Common Stock -- -- -- -- -- 200,865 shares D N/A
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Common Stock -- -- -- -- -- 19,500 shares I (1)
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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 $10.125/sh. 10/08/98 A 176,000 -- (2) 10/08/08 Common 176,000 --
(Right to buy) Stock
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Employee Stock Options $10.125/sh. 10/08/98 A 107,000 -- 12/19/99 10/08/08 Common 107,000 --
(Right to buy) Stock
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Employee Stock Options $18.63/sh. 10/08/98 D -- 176,000 (3) 10/27/07 Common 176,000 --
(Right to buy) Stock
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Employee Stock Options $25.75/sh. 10/08/98 D -- 107,000 06/19/99 06/19/08 Common 107,000 --
(Right to buy) Stock
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Employee Stock Options $8.38/sh. -- -- -- -- (4) 01/02/07 Common 245,000 --
(Right to buy) Stock
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Employee Stock Options $7.63/sh. -- -- -- -- (5) 09/19/06 Common 100,000 --
(Right to buy) Stock
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Employee Stock Options $5.00/sh. -- -- -- -- (6) 09/07/05 Common 49,000 --
(Right to buy) Stock
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Warrants $26.00/sh. 12/18/98 A 5,000 -- immed. 06/17/01 Common 5,000 --
(Right to buy) Stock
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Warrants $19.00/sh. -- -- -- -- immed. 09/09/02 Common 5,250 --
(Right to buy) Stock
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Warrants $22.00/sh. -- -- -- -- immed. 09/09/00 Common 2,250 --
(Right to buy) Stock
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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 176,000 D N/A
(Right to buy)
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Employee Stock Options 107,000 D N/A
(Right to buy)
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Employee Stock Options 0 D N/A
(Right to buy)
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Employee Stock Options 0 D N/A
(Right to buy)
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Employee Stock Options 245,000 D N/A
(Right to buy)
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Employee Stock Options 100,000 D N/A
(Right to buy)
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Employee Stock Options 49,000 D N/A
(Right to buy)
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Warrants 5,000 I (7)
(Right to buy)
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Warrants 5,250 I (7)
(Right to buy)
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Warrants 2,250 I (7)
(Right to buy)
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Explanation of Responses:
(1) These shares of Common Stock are held directly by Helix Capital II, L.L.C., which
is controlled, in part, by Mr. Stern.
(2) These Employee Stock Options vest in two equal installments on 4/27/99 and 10/27/00.
(3) These Employee Stock Options were to vest in two equal installments on 10/27/98
and 10/27/99.
(4) These Employee Stock Options were acquired 01/02/97 and vest in two equal installments
on 01/02/98 and 01/02/99.
(5) These Employee Stock Options were acquired 09/19/96 and vest in three equal installments
on 09/19/97, 09/19/98 and 09/19/99.
(6) These Employee Stock Options were acquired 09/07/95 and vest in three equal installments
on 09/07/96, 09/07/97 and 09/07/98.
(7) These Warrants are held by Helix Capital II, L.L.C., which is controlled, in part, by Mr. Stern.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Yoav Stern 2/11/99
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- -------
**Signature of Reporting Person Date
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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