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FORM 5 OMB APPROVAL
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[ ] Check this box if no longer OMB Number 3235-0362
subject to Section 16. Form 4 Expires: December 31, 2001
or Form 5 obligations may continue. Estimated average burden
See Instruction 1(b). hours per response.............. 1.0
[ ] Form 3 Holdings Reported -------------------------------------
[X] Form 4 Transactions Reported
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(f) of the
Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Li Theodore S.
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(Last) (First) (Middle)
1600 California Circle
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(Street)
Milpitas CA 95035
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(City (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Pacific Magtron International Corp. (PMIC)
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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
May 2001
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5. If Amendment, Date of Original
(Month/Year)
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[X] Director [X] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
President
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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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1.Title of Security 2.Trans- 3.Trans- 4.Securities Acquired (A) 5.Amount of 6.Owner- 7.Nature of
(Instr. 3) action action or Disposed of (D) Securities Ben- ship Indirect
Date Code (Instr. 3, 4 and 5) eficially Owned Form: Di- Beneficial
(Month/ (Instr.8) ------------------------ at end of rect (D) Ownership
Day/ (A) or Issuer's Fiscal or Indi- (Instr. 4)
Year) Amount (D) Price Year (Instr. 3 rect (I)
and 4) (Instr. 4)
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* If the form is filed by more than one reporting person, see Instruction
4(b)(v). Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently valid OMB Number.
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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 2.Conver- 3.Trans- 4.Transac- 5.Number of Deriva-
(Instr. 3) sion or action tion tive Securities
Exer- Date Code Acquired (A) or
cise (Month/ (Instr.8) Disposed of (D)
Price of Day/ (Instr. 3,4, and 5)
Deriva- Year)
tive Se- -------------------
curity (A) (D)
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Stock Option (Right to Buy) $.97 5/4/01 A4 103,092
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Stock Option (Right to Buy) $.88 5/4/01 A4 146,908
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6.Date Exercis- 7.Title and Amount of 8.Price 9.Number 10.Owner- 11.Nature
able and Expi- Underlying Securities of of De- ship of of Indi-
ration Date (Instr. 3 and 4) De- rivative Deriva- rect Ben-
(Month/Day/ riva- Securi- tive Se- eficial
Year) tive ties Ben- curity: Owner-
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Date Expira- Amount or rity Owned at (D) or (Instr.4)
Exer- tion Number of (Instr. 5) End of Year Indirect
cisable Date Title Shares Year(Instr.4) (I)(Instr.4)
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5/4/01 5/3/06 Common Stock 103,092 D
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5/4/01 5/3/06 Common Stock 146,908 D
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Explanation of Responses:
/s/ Theodore S. Li February 14, 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).