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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 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(h) of the Investment Company Act of 1940
|_| Check 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
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1. Name and Address of Reporting Person*
Balaban Sigmund A.
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(Last) (First) (Middle)
10 Grecian Street
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(Street)
Parsippany New Jersey 07054
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
ARC Wireless Solutions, Inc. (ARCS)
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3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)
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4. Statement for Month/Year
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5. If Amendment, Date of Original (Month/Year)
December 2001
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|X| Director |_| 10% Owner
| | Officer (give title below) |_| Other (specify below)
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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 I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
2A. 3. Disposed of (D) Beneficially Form: 7.
2. Deemed Transaction (Instr. 3, 4 and 5) Owned Direct Nature of
Trans- Execution Code ------------------------------- at the End (D) or Indirect
1. action Date, if (Instr. 8) (A) of Issuer's Indirect Beneficial
Title of Security Date any ------------ or Fiscal Year (I) Ownership
(Instr. 3) (mm/dd/yy) (mm/dd/yy) Amount (D) Price (Instr. 3 & 4) (Instr.4) (Instr.4)
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Common Stock 1/8/01 A 431 A $.58(1) D
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Common Stock 2/21/01 A 781 A $.32(1) D
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Common Stock 5/01/01 A 694 A $.36(1) D
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Common Stock 5/29/01 A 714 A $.35(1) D
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Common Stock 7/26/01 A 178 A $.28(1) D
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Common Stock 8/21/01 A 200 A $.25(1) D
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Common Stock 12/4/01 A 294 A $.17(1) 1,419,169 D
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(1) Acquired pursuant to the Issuer's 1997 Stock Option And Compensation Plan
in lieu of Mr. Balaban's outside Director's Meeting Fee of $250 per the first
four meetings of the Board Of Directors he attended during 2001 and $50 per each
subsequent meeting attended during 2001. The amount of shares was determined
according to the closing price of the Common Stock on the applicable meeting
dates.
* If the form is filed by more than one reporting person, see instruction
4(b)(v).
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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10.
9. Owner-
Number ship
2. of of
Conver- 5. 7. Deriv- Deriv- 11.
sion Number of Title and Amount ative ative Nature
or Derivative 6. of Underlying 8. Secur- Secur- of
Exer- 3A. 4. Securities Date Securities Price ities ity: In-
cise Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Bene- Direct direct
Price 3. Execut- action or Disposed Expiration Date ---------------- Deriv- ficially (D) or Bene-
1. of Trans- ion Code of(D) (Month/Day/Year) Amount ative Owned In- ficial
Title of Deriv- action Date if (Instr. (Instr. 3, ---------------- or Secur- at End direct Owner-
Derivative ative Date any 8) 4 and 5) Date Expira- Number ity of Year (I) ship
Security Secur- (mm/dd/ (mm/dd/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity yy) yy) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Option: Common
Right To Buy $.15 09/8/99 9/8/04 Stock 250,000 0 100,000(2) D
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Option: Common
Right To Buy $.28 7/26/01 A 25,000 7/26/01 7/26/03 Stock 25,000(3) 0 25,000(3) D
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Explanation of Responses:
(2) In accordance with the 1997 Stock Option And Compensation Plan, for Mr. Balaban's services as an outside director he previously
received a grant of options to purchase 250,000 shares, with 50,000 options becoming exercisable for each the Board Of Directors
meetings he attended through May 24, 2000. Mr. Balaban previously exercised options to purchase 150,000 shares.
(3) In accordance with the 1997 Stock Option And Compensation Plan and the Issuer's revised policies concerning options granted to
outside directors, on July 26, 2001, Mr. Balaban received a grant of options to purchase 25,000 shares with a term of two years,
5,000 of which became exercisable upon his attendance at the Board meeting held on that date and 5,000 of which will become
exercisable for each Board meeting he subsequently attends.
/s/ Sigmund A. Balaban 11/13/2002
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**Signature of Reporting Person Date
** 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.