FORM 5 ¨ Check this box if no longer subject toSection 16. Form 4 or Form 5 obli- gations may continue. See Instruc tion 1(b). ¨ Form 3 Holdings Reportedý Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION 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 |
OMB APPROVAL _________________________________________________ OMB Number: 3235-0362 Expires: Estimated average burden hours per response . . . . .1.0 |
1. Name and Address of Reporting Person |
2. Issuer Name and Ticker or Trading Symbol |
6. Relationship of Reporting Person to Issuer |
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Rybakoff James B. |
Grand Toys International, Inc. ("GRIN") |
(Check all applicable) X Director _______10% Owner |
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(Last) (First) (Middle) |
3. IRS or Social Security |
4. Statement for Month/Year |
Officer (give _______Other (specify title below below) |
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780 Third Avenue |
December 2001 |
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(Street) New York, New York 10017 |
5. If Amendment, Date of Original (Month/Year) |
7. Individual or Joint/Group Reporting __X Form Filed by One Reporting Person ____ Form Filed by More than One Reporting Person |
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(City) (State) (Zip) |
Table I Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1. Title of Security (Instr. 3) |
2. Trans- (Month/ Day/ Year) |
3. Trans- |
4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
5. Amount of Securities Bene- ficially Owned at End of Issuer's Fiscal Year (Instr. 3 and 4) |
6.Owner- ship Form: Direct (D) or Indirect (I) |
7. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Amount |
(A) or |
Price |
(Instr.4) |
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*If the form is filed by more than one reporting person, see instruction 4(b)(v). (Over) (Print or type responses) SEC 2270 (7/96)
FORM 5 (continued) 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. Conver- sion or Exercise Price of Deriv- ative Security |
3. Trans- action Date (Month/ Day/ Year) |
4. Trans- action Code (Instr. 8) |
5. Number of Deriv- ative Securities Ac- quired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
6. Date Exer- cisable and Expiration Date (Month/Day/ Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8.Price of Deriv- ative Secur- ity (Instr. 5) |
9. Number of Deriv- ative Secur- ities Bene- ficially Owned at End |
10.Owner ship Form of De- rivative Secu- rity: Direct (D) or |
11. Na-ture of In- direct Bene- ficial Own- ership (Instr. 4) |
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(A) |
(D) |
Date Exer-cisable |
Expira-tion Date |
Title |
Amount or Number ofShares |
of Month (Instr. 4) |
Indi- rect (I) (Instr. 4) |
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Common Stock Option |
$0.3438 |
1/1/01 |
A |
500 |
-- |
1/1/01 |
1/1/11 |
Common Stock |
500 |
$0.3438 |
3,000 |
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Common Stock Option |
$1.124 |
4/1/01 |
A |
500 |
-- |
4/1/01 |
4/1/11 |
Common Stock |
500 |
$1.124 |
3,500 |
D
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Common Stock Option |
$1.00 |
10/1/01 |
A |
125 |
-- |
10/1/01 |
10/1/11 |
Common Stock |
125 |
$ 1.00 |
3,625 |
D
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By Akin Bay Co. (1) |
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Explanation of Responses: (1) Warrants to purchase 55,000 shares of common stock are owned of record by Akin Bay Company LLC, of which Mr. Rybakoff is a controlling member. |
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
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.
If space provided is insufficient, see Instruction 6 for procedure.
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SEC 2270 (7/96)