UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
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
[X] Check box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
[X] Form 3 Holdings Reported.
[_] Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
Gordon, Robert
444 Madison Avenue, Suite 2904
New York, New York 10022
2. Issuer Name and Ticker or Trading Symbol
Lifen, Inc. (None)
3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
4. Statement For Month/Year
8/02
5. If Amendment, Date of Original (Month/Year)
6. Relationship of Reporting Person to Issuer (Check all applicable)
[ ] Director
[ ] Officer (give title below)
[ ] 10% Owner
[X] Other (specify below)
Resigned as officer and director effective 8/16/02.
7. Individual or Joint/Group Filing (Check applicable line)
[X] Form filed by One Reporting Person
[ ] Form filed by More Than One Reporting Person
* If the Form is filed by more than one Reporting Person,
see Instruction 4(b)(v).
Table I - Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of
Security action action or Disposed of (D) Securities Form: Indirect
(Instr.3) Date Code (Instr.3, 4 and 5) Beneficially Direct (D) or Beneficial
(Month/ (Instr.8) --------------------------- Owned at End Indirect (I) Ownership
Day/ of Issuer's (Instr.4) (Instr.4)
Year) Amount (A) or (D) Price Fiscal Year
(Instr.3 and 4)
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Common Stock 8/31/02 N/A NONE N/A N/A 760,000 D N/A
Table II - Derivative Securities Acquired, disposed of, or Beneficially Owned
(e.g., Puts, Calls, Warrants, Options, Convertible Securities)
1.Title of 2.Conver- 3.Trans- 4.Trans- 5.Number of 6.Date 7.Title and 8.Price 9.Number 10.Ownership 11.Nature
Deriva- sion or action action Derivative Exercisable Amount of of of of of
tive Exercise Date Code Securities and Underlying Deriva- Deriva- Derivative Indirect
Security Price of (Month/ (Instr. Acquired Expiration Securities tive tive Security: Benefi-
(Instr.3) Deriva- Day/ 8) (A) or Date (Instr.3 Security Securit- Direct (D) cial
tive Year) Disposed (Month/Day/ and 4) (Instr. ies or Owner-
Security of (D) Year) --------------- 5) Benefi- Indirect(I) ship
(Instr.3, ----------------- Title Amount of cially (Instr.4) (Instr.4)
4, and 5) Date Expira- Number of Owned at
----------- Exercis- tion Shares End of
(A) (D) able Date Year
(Instr.4)
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NONE
Explanation of Responses:
/s/ Robert Gordon 10/10/02
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Signature of Reporting Person (1) Date
(1) 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 provided is insufficient, see Instruction 6 for procedure.