U.S. 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(f) 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*
Smiley Martin S
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(Last) (First) (Middle)
c/o mPhase Technologies, Inc.
587 Connecticut Avenue
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(Street)
Norwalk CT 06854
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
mPhase Technologies, Inc. (XDSL)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
August 2001
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
Chief Financial Officer
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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
Disposed of (D) Beneficially Form: 7.
3. (Instr. 3, 4 and 5) Owned at End Direct Nature of
2. Transaction ----------------------------- of Issuer's (D) or Indirect
1. Transaction Code (A) Fiscal Year Indirect Beneficial
Title of Security Date (Instr. 8) Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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Common Stock 215,834 D
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* If the form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses) (Over)
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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9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr.8) ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Employee Stock $4.625 10/30/00 A V 30,000 10/30/00 10/30/05 Common 30,000 30,000 D
Option (right to Stock
buy)
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Employee Stock $1.50 12/29/00 A V 60,000 12/29/00 12/29/05 Common 60,000 90,000 D
Option (right to Stock
buy)
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Employee Stock $1.05 4/17/01 A V 205,000 4/17/01 4/17/06 Common 205,000 295,000 D
Option (right to Stock
buy)
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Employee Stock $0.54 8/17/01 A V 250,000 8/17/01 8/17/06 Common 250,000 545,000 D
Option (right to Stock
buy)
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Employee Stock $7.1875 8/21/00 A 125,000 (1) 8/21/05 Common 125,000 670,000 D
Option (right to Stock
buy)
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Common Stock $3.00 1/30/01 A 25,000 1/3/01 1/25/05 Common 25,000 695,000 D
Warrants (right Stock
to buy)
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Explanation of Responses:
(1) the options vest in four equal installments on Feb. 21, 2001, Aug. 21, 2001,
Feb. 21, 2002 and Aug. 21, 2002.
/s/ Martin Smiley 11/29/01
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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.
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