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 or Section 30(h) of the Investment Company Act of 1940 |
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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. | |||||||||||||||||
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Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
EMAGIN CORP [ EMA ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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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)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
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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 at end of Issuer's Fiscal Year (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 | 11/04/2003 | X4 | 33,333 | D | $0.53 | 7,796,543 | I | By Subsidiary(1) | |||||||
Common Stock | 12/01/2003 | X4 | 96,666 | D | $0.53 | 7,699,877 | I | By Subsidiary(1) | |||||||
Common Stock | 12/01/2003 | X4 | 26,666 | D | $0.53 | 7,673,211 | I | By Subsidiary(1) | |||||||
Common Stock | 12/01/2003 | X4 | 26,666 | D | $0.53 | 7,646,545 | I | By Subsidiary(1) | |||||||
Common Stock | 12/19/2003 | X4 | 83,333 | D | $0.53 | 7,563,212 | I | By Subsidiary(1) | |||||||
Common Stock | 12/22/2003 | X4 | 1,733,335 | D | $0.53 | 5,829,877 | I | By Subsidiary(1) | |||||||
Common Stock | 12/22/2003 | X4 | 666,667 | D | $0.53 | 5,163,210 | I | By Subsidiary(1) | |||||||
Common Stock | 12/27/2003 | X4 | 1,333,334 | D | $0.53 | 3,829,876 | I | By Subsidiary(1) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | ||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise 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 | |||||||||
Call Options (obligation to sell) | (2) | 04/25/2003 | 4S | 4,000,000 | (2) | (2) | Common Stock | 4,000,000 | 4,000,000 | 0 | I | By Subsidiary(1) | ||
Call Options (obligation to sell) | (2) | 11/04/2003 | 4X | 33,333 | (2) | (2) | Common Stock | 33,333 | 33,333 | 0 | I | By Subsidiary(1) | ||
Call Options (obligation to sell) | (2) | 12/01/2003 | 4X | 96,666 | (2) | (2) | Common Stock | 96,666 | 96,666 | 0 | I | By Subsidiary(1) | ||
Call Options (obligation to sell) | (2) | 12/01/2003 | 4X | 26,666 | (2) | (2) | Common Stock | 26,666 | 26,666 | 0 | I | By Subsidiary(1) | ||
Call Options (obligation to sell) | (2) | 12/01/2003 | 4X | 26,666 | (2) | (2) | Common Stock | 26,666 | 26,666 | 0 | I | By Subsidiary(1) | ||
Call Options (obligation to sell) | (2) | 12/19/2003 | 4X | 83,333 | (2) | (2) | Common Stock | 83,333 | 83,333 | 0 | I | By Subsidiary(1) | ||
Call Options (obligation to sell) | (2) | 12/22/2003 | 4X | 1,733,335 | (2) | (2) | Common Stock | 1,733,335 | 1,733,335 | 0 | I | By Subsidiary(1) | ||
Call Options (obligation to sell) | (2) | 12/22/2003 | 4X | 666,667 | (2) | (2) | Common Stock | 666,667 | 666,667 | 0 | I | By Subsidiary(1) | ||
Call Options (obligation to sell) | (2) | 12/27/2003 | 4X | 1,333,334 | (2) | (2) | Common Stock | 1,333,334 | 1,333,334 | 0 | I | By Subsidiary(1) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. The Travelers Insurance Company ("Travelers") directly beneficially owns the securities reported herein. Travelers is a wholly owned subsidiary of Citigroup Insurance Holding Corporation ("Citigroup Insurance"), which is a wholly owned subsidiary of Associated Madison Companies, Inc. ("Associated Madison"), which is a wholly owned subsidiary of Citigroup Inc. ("Citigroup"). Each of Citigroup Insurance, Associated Madison and Citigroup disclaims beneficial ownership of the securities reported herein except to the extent of their pecuniary interest therein. |
2. The options had an exercise price of $0.53 per share, were exercisable immediately, and had an expiration date of December 31, 2003. |
3. The options were granted in consideration for certain investments in the Issuer that were made in connection with refinancing transactions that occurred in April 2003. |
Citigroup Inc., By Serena D. Moe, Assistant Secretary | 01/22/2004 | |
Citigroup Insurance Holding Corporation, By: Serena D. Moe, Assistant Secretary | 01/22/2004 | |
Associated Madison Companies Inc., By: Serena D. Moe, Assistant Secretary | 01/22/2004 | |
The Travelers Insurance Company, By: Serena D. Moe, Assistant Secretary | 01/22/2004 | |
** 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. |