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 |
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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. | |||||||||||||||||
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Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
DOVER SADDLERY INC [ DOVR ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 12/31/2008 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
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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 | 519,587(1) | D | |||||||||||||
Common Stock | 09/15/2008 | 09/15/2008 | P4 | 5,000 | A | $2.9496 | 524,587(2) | D |
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 (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 | |||||||||
Incentive Stock Option | $2.14 | (3) | 12/30/2009 | Common Stock | 76,937 | 76,937(4) | D | |||||||
Incentive Stock Option | $10 | 12/30/2005 | 11/16/2015 | Common Stock | 3,500 | 80,437(5) | D | |||||||
Incentive Stock Option | $8.25 | (6) | 10/25/2011 | Common Stock | 15,725 | 96,162(7) | D | |||||||
Non-Qualified Stock Option | $7.5 | (6) | 10/25/2016 | Common Stock | 3,500 | 3,500(8) | D | |||||||
Incentive Stock Option | $4.95 | (9) | 11/13/2012 | Common Stock | 15,725 | 111,887(10) | D | |||||||
Non-Qualified Stock Option | $4.5 | (9) | 11/13/2017 | Common Stock | 3,500 | 7,000(11) | D | |||||||
Incentive Stock Option | $1.36 | 11/21/2008 | 4A | 13,220 | (12) | 11/20/2013 | Common Stock | 13,220 | (13) | 125,107(14) | D | |||
Non-Qualiifed Stock Option | $1.24 | 11/21/2008 | 4A | 2,940 | (12) | 11/20/2018 | Common Stock | 2,940 | (15) | 9,940(16) | D |
Explanation of Responses: |
1. As of 12/31/2007. |
2. As of 12/31/2008. |
3. Immediately. |
4. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2004. |
5. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2005. |
6. Granted on 10/26/2006 and vest on anniversary date of grant at rate 20 % per year for five years. |
7. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2006. Together with Non-Qualified Stock Options the total stock options held by this reporting person equals 99,662 as of 12/31/2006. |
8. Reflects total outstanding Non-Qualified Stock Options held by this reporting person as of 12/31/2006. Together with Incentive Stock Options the total stock options held by this reporting person equals 99,662 as of 12/31/2006. |
9. Granted on 11/14/2007 and vest on anniversary date of grant date at rate 20 % per year for five years. |
10. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2007. Together with Non-Qualified Stock Options the total stock options held by this reporting person equals 118,887 as of 12/31/2007. |
11. Reflects total outstanding Non-Qualified Stock Options held by this reporting person as of 12/31/2007. Together with Incentive Stock Options the total stock options held by this reporting person equals 118,887 as of 12/31/2007. |
12. Vest on anniversary date of grant at rate 20 % per year for five years. |
13. When exercisable price will be $ 1.36. |
14. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2008. Together with Non-Qualified Stock Options the total stock options held by this reporting person equals 135,047 as of 12/31/2008. |
15. When exercisable price will be $ 1.24. |
16. Reflects total outstanding Non-Qualified Stock Options held by this reporting person as of 12/31/2008. Together with Incentive Stock Options the total stock options held by this reporting person equals 135,047 as of 12/31/2008. |
Remarks: |
All transactions reported on this Form 5 have been previously reported on Forms 3 and 4 in a timely manner. |
Stephen L. Day | 02/13/2009 | |
** 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. |