FORM 5 |
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 or Section 30(h) of the Investment Company Act of 1940 |
|
|||||||||||||||
Check this 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. |
1. Name and Address of Reporting Person*
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
BLOUNT INTERNATIONAL INC [ BLT ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
||||||||||||||||||||||||
3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 12/31/2003 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
Amount | (A) or (D) | Price | |||||||||||||
Common Stock | 08/19/1999 | J | 1,176 | A | (1) | 1,176 | D | ||||||||
Common Stock | 12/31/2003 | J | 347.9423 | D | (2) | 0 | I | Blount International, Inc. 401(k) Plan | |||||||
Common Stock | 08/19/1999 | J | 42,624 | A | (3) | 42,624 | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
1999 Stock Incentive Plan (Right to Buy) | $15 | 08/19/1999 | J | 60,000 | (4) | 08/18/2009 | Common Stock | 60,000 | $15 | 60,000 | D | |||
1999 Stock Incentive Plan (Right to Buy) | $15 | 08/19/1999 | J | 60,000 | (5) | 08/18/2009 | Common Stock | 60,000 | $15 | 60,000 | D | |||
2000 Stock Incentive Plan (Right to Buy) | $5 | 06/29/2001 | J | 150,000 | (6) | 06/29/2011 | Common Stock | 150,000 | $5 | 150,000 | D | |||
2000 Stock Incentive Plan (Right to Buy) | $2.85 | 03/15/2002 | J | 150,000 | (7) | 03/15/2012 | Common Stock | 150,000 | $2.85 | 150,000 | D | |||
2000 Stock Incentive Plan (Right to Buy) | $3.028 | 02/14/2002 | J | 39,400 | (7) | 02/19/2012 | Common Stock | 39,400 | $3.028 | 39,400 | D |
Explanation of Responses: |
1. Shares of Blount International, Inc. Class A common stock converted 2-for-1 shares of Blount International, Inc. common stock. |
2. Rebalanced 401(k) account on July 8, 2003 which in effect dropped balance to zero in Blount Stock Fund. |
3. In connection with merger of Red Dog Acquisition Corp. into Blount International, Inc. on August 19, 1999, all outstanding stock options were cancelled and the spread between exercise price and $30 was paid in cash and stock to employee. |
4. Vests 33.33% on each succeeding anniversary date of grant for three years. |
5. Vesting subject to meeting financial targets with up to 20% per year. Vesting also occurs 100% after six years. |
6. Vests 33.33% on June 29, 2002 and 100% on February 9, 2003. |
7. Vests 100% on date of grant. |
Remarks: |
Richard H. Irving, III | 02/02/2004 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |