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OMB APPROVAL
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OMB Number 3235-0362
Expires September 30, 1998
Estimated average
burden hours per
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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*
INGLESE MICHAEL J.
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(Last) (First) (Middle)
PanAmSat Corporation
20 Westport Road
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(Street)
Wilton Connecticut 06897
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
PanAmSat Corporation (SPOT)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
December, 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)
Senior Vice President and 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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6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
Disposed of (D) Securities Form: 7.
(Instr. 3, 4 and 5) Beneficially Direct Nature of
2. 3. ----------------------------- Owned at End (D) or Indirect
1. Transaction Transaction (A) of Month Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) Month/Day/Year (Instr. 8) (D) and 4) (Instr.4) (Instr. 4)
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Common Stock, par value $0.01 per
share 609.604(1) I (1)
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* If the form is filed by more than one Reporting Person, see Instruction
4(b)(v).
(Print or Type Responses)
(Over)
SEC 2270 (7/96)
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- Form 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. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Employee Stock
Option (right Common
to buy) $38.188 1/23/01 A 30,000 (2) 1/23/11 Stock 30,000 $0 30,000 D
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Explanation of Responses: (1) Based on interests held in a PanAmSat Stock Fund
of the PanAmSat Corporation Retirement Savings Plan 401(k).
(2) These options become exercisable as to 7,500 shares on each of January 23,
2002, January 23, 2003, January 23, 2004 and January 23, 2005.
/s/ James Cuminale, Attorney-in-Fact February 8, 2002
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Michael J. Inglese Date
By: James Cuminale, Attorney-in-Fact
** 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.
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.