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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
Miller, II George M. Sirrom Capital Corporation (SIR) Issuer (Check all applicable)
- ------------------------------------------- ---------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
500 Church Street, Suite 200 Number of Reporting Month/Year X Officer (give Other (specify
- ------------------------------------------- Person (Voluntary) 1/99 ---- title --- below)
(Street) ------------------- below)
Nashville TN 37219 5. If Amendment, Chief Executive Officer
- ------------------------------------------- Date of Original -------------------------------
(City) (State) (Zip) (Month/Year)
2/99 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. 8) End of Issuer's Direct Benefi-
(Month/ 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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*If the form is filed by more than one reporting person, see instruction 4(b)(v).
(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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Stock Option $ 23.875 10/1/98 D 600,000 (1) 10/10/07 Common 600,000
Stock
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Stock Option $9.25 10/1/98 D 91,146 (1) 12/15/05 Common 91,146
Stock
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Stock Option $9.3125 10/1/98 D 59,146 (1) 2/1/06 Common 59,146
Stock
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Stock Option $9.3125 10/1/98 D 37,572 (1) 2/1/06 Common 37,572
Stock
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Stock Option $5.50 10/1/98 D 225,000 (1) 2/3/05 Common 225,000
Stock
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Stock Option $15.00 10/1/98 D 448,230 (1) 10/01/06 Common 448,230
Stock
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Stock Option $3.5625 10/1/98 A 180,000 (2) 2/3/05 Common 180,000
Stock
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Stock Option $3.5625 10/1/98 A 74,056 (3) 12/15/05 Common 74,056
Stock
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Stock Option $3.5625 10/1/98 A 31,572 (4) 2/1/06 Common 31,572
Stock
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Stock Option $3.5625 10/1/98 A 48,056 (5) 2/1/06 Common 48,056
Stock
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Stock Option $3.5625 10/1/98 A 380,996 (6) 10/1/06 Common 380,996
Stock
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Stock Option $3.5625 10/1/98 A 510,000 (7) 10/10/07 Common 510,000
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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Stock Option D
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Stock Option D
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Stock Option D
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Stock Option D
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Stock Option D
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Stock Option D
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Stock Option D
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Stock Option D
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Stock Option D
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Stock Option D
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Stock Option D
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Stock Option 1,224,680 D
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Explanation of Responses:
(1) These options are subject to various vesting periods.
(2) This option is vested as to 75,000 shares and shall become fully vested on August 1, 1999.
(3) This option is vested as to 39,877 shares and will vest as to an additional 17,090 shares each year beginning December 15, 1999.
(4) This option is vested as to 13,572 shares and will vest as to an additional 6,000 shares each year beginning February 1, 1999.
(5) This option is vested as to 14,787 shares and will vest as to an additional 11,090 shares each year beginning February 1, 1999.
(6) This option is vested as to 179,292 shares and will vest as to an additional 67,235 shares each year beginning October 1, 1999.
(7) This option is vested as to 102,000 shares and will vest as to an additional 102,000 shares each year beginning October 10,
1999.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ George M. Miller II 2-16-99
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. SEC 2270(3/91)
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