Building Canna-business From the Ground Up to the Cloud
Annual statement of changes in beneficial ownership of securities
5
FORM 5
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
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(h) of the Investment Company Act of 1940
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OMB Number:
3235-0362
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hours per response
1.0
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See Instruction 1(b).
Form 3 Holdings Reported.
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
THATHAM VASAN
(Last)
(First)
(Middle)
ONE BLUE HILL PLAZA, 7TH FLOOR
(Street)
PEARL RIVER
NY
10965
(City)
(State)
(Zip)
2. Issuer Name and Ticker or Trading Symbol
PROVO INTERNATIONAL INC [FNT]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director
10% Owner
X
Officer (give title below)
Other (specify below)
Chief Financial Officer
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year) 12/31/2003
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X
Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)
2. Transaction Date(Month/Day/Year)
2A. Deemed Execution Date, if any(Month/Day/Year)
3. Transaction Code (Instr. 8)
4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount
(A) or (D)
Price
Common Stock
01/30/2004
J
0
A
$
0
163,667
(1)
D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)
2. Conversion or Excercise Price of Derivative Security
3. Transaction Date (Month/Day/Year)
3A. Deemed Execution Date, if any(Month/Day/Year)
4. Transaction Code (Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
6. Date Exercisable and Expiration Date (Month/Day/Year)
7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)
8. Price of Derivative Security (Instr. 5)
9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
11. Nature of Indirect Beneficial Ownership (Instr. 4)
(A)
(D)
Date Exercisable
Expiration Date
Title
Amount or Number of Shares
Stock Options
$
9.09
01/30/2004
J(2)
13,334
01/13/1999
01/13/2004
Common
13,334
$
0
66,667
D
Stock Options
$
8.48
01/30/2004
J(2)
666
09/21/1999
09/21/2004
Common
666
$
0
66,667
D
Stock Options
$
7.13
01/30/2004
J(2)
20,000
10/01/1999
10/01/2004
Common
20,000
$
0
66,667
D
Stock Options
$
7.88
01/30/2004
J(2)
6,667
12/23/1999
12/23/2004
Common
6,667
$
0
66,667
D
Stock Options
$
2.16
01/30/2004
J(2)
1,333
06/02/2000
06/02/2005
Common
1,333
$
0
66,667
D
Stock Options
$
0.75
01/30/2004
J(2)
6,667
11/08/2000
11/08/2005
Common
6,667
$
0
66,667
D
Stock Options
$
0.33
01/30/2004
J(2)
18,000
04/01/2001
04/01/2006
Common
18,000
$
0
66,667
D
Reporting Owner Name / Address
Relationships
Director
10% Owner
Officer
Other
THATHAM VASAN ONE BLUE HILL PLAZA, 7TH FLOOR PEARL RIVER,NY10965
Chief Financial Officer
Explanation of Responses:
1. Adjusted to give effect to a 2 for 3 reverse split of the Company's securities, which took effect on 01/31/04.
2. Represents adjustment of previously issued stock options to reflect the two for three reverse split of the Company's securities, which took effect on January 30, 2004.
Vasan Thatham
02/13/2004
** Signature of Reporting Person
Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person,
see
Instruction
4
(b)(v).
** 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 is insufficient,
see
Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.