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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Non-Qualified Stock Option (right to buy) | $ 8.595 | 12/31/2004 | D(1) | 20,000 | (1) | 04/16/2013 | Common Stock | 20,000 | $ 0 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 8.595 | 12/31/2004 | A(1) | 5,000 | (1) | 04/16/2013 | Common Stock | 5,000 | $ 0 | 5,000 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 19.245 | 12/31/2004 | D(1) | 28,000 | (1) | 04/28/2014 | Common Stock | 28,000 | $ 0 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 20.8125 | 12/31/2004 | D(1) | 175,000 | (1) | 05/11/2007 | Common Stock | 175,000 | $ 0 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 20.8125 | 12/31/2004 | A(1) | 100,000 | (1) | 05/11/2007 | Common Stock | 100,000 | $ 0 | 100,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
LEPOFSKY ROBERT NINE HAMPSHIRE STREET MANSFIELD, MA 02048 |
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By: Beverly L. Couturier, Attorney-in-Fact For: Robert J. Lepofsky | 01/04/2005 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Mr. Lepofsky's stock options that were vested as of December 31, 2004, were amended as of that date to extend the period in which those options can be exercised from one month to one year following his retirement as President and Chief Executive Officer on December 31, 2004. Options held by Mr. Lepofsky that were not vested as of December 31, 2004, were terminated, including options to purchase 75,000 shares at $20.8125 per share; 15,000 shares at $8.595 per share; and 28,000 shares at $19.24 per share. For reporting purposes only, the extension is described herein as the deemed cancellation of all of Mr. Lepofsky's outstanding stock options as of December 31, 2004, and the re-grant of the portion of such options that were vested as of December 31, 2004. |