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) 12/31/2012 | ||||||||||||||||||||||||||
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 | 22,606(1) | D | |||||||||||||
Common Stock | 11/26/2012(2) | 11/26/2012 | P4 | 2,644 | A | $1.24 | 25,250(3) | 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 | $7.5 | (4) | 10/25/2016 | Common Stock | 15,725 | 81,269(5) | D | |||||||
Incentive Stock Option | $4.5 | (6) | 11/13/2017 | Common Stock | 15,725 | 81,269(7) | D | |||||||
Incentive Stock Option | $1.24 | (8) | 11/20/2018 | Common Stock | 2,644(9) | 81,269(10) | D | |||||||
Incentive Stock Option | $3.1 | (11) | 11/16/2020 | Common Stock | 15,725 | 81,269(12) | D | |||||||
Incentive Stock Option | $3.32 | (13) | 11/27/2021 | Common Stock | 15,725 | 81,269(14) | D | |||||||
Incentive Stock Option | $3.59 | 11/16/2012(2) | 4A | 15,725 | (15) | 11/15/2022 | Common Stock | 15,725 | (16) | 81,269(17) | D | |||
Incentive Stock Option | $1.24 | 11/26/2012(2) | 11/26/2012 | 4C | 2,644 | (18) | 11/20/2018 | Common Stock | 2,644 | (19) | 81,269(20) | D |
Explanation of Responses: |
1. As of 12/31/2011. |
2. This transaction has been previously reported on a Form 4 filed in a timely manner. |
3. As of 12/31/2012. Reflects total shares of common stock held by this reporting person, after exercising Incentive Stock Options to purchase a total of 2,644 shares of Common Stock in 2012, as reported in Table II. |
4. Granted on 10/26/2006 and vest on anniversary date of grant at rate 20 % per year for five years. |
5. As of 12/31/2012, total includes 15,725 Incentive Stock Options as granted in 2006. |
6. Granted on 11/14/2007 and vest on anniversary date of grant at rate 20 % per year for five years. |
7. As of 12/31/2012, total includes 15,725 Incentive Stock Options as granted in 2007. |
8. Granted on 11/21/2008 and vest on anniversary date of grant at rate 20 % per year for five years |
9. A total of 13,220 Incentive Stock Options were granted in 2008; of this award 2,644 vested options have been purchased by the reporting person on 6/3/2010, of this award 2,644 vested options have been purchased by the reporting person on 1/31/2011, of this award 2,644 vested options have been purchased by the reporting person on 11/21/2011 and of this award 2,644 vested options have been purchased by the reporting person on 11/26/2012. |
10. As of 12/31/2012, total includes 2,644 Incentive Stock Options as granted in 2008. |
11. Granted on 11/17/2010 and vest on anniversary date of grant at rate 20 % per year for five years. |
12. As of 12/31/2012, total includes 15,725 Incentive Stock Options as granted in 2010. |
13. Granted on 11/28/2011 and vest on anniversary date of grant at rate 20 % per year for five years. |
14. As of 12/31/2012, total includes 15,725 Incentive Stock Options as granted in 2011. |
15. Granted on 11/16/2012 and vest on anniversary date of grant at rate 20 % per year for five years. |
16. When exercisable price will be $ 3.59. |
17. As of 12/31/2012, total includes 15,725 Incentive Stock Options as granted in 2012. |
18. 13,220 Incentive Stock Options were granted in 11/21/2008 and vest on anniversary date of grant at rate 20% per year for five years. |
19. Price at time of exercise was $1.24. |
20. As of 12/31/2012. |
Remarks: |
All transactions reported on this Form 5 have been previously reported on Forms 3 and 4 in a timely manner. |
/s/ William G. Schmidt | 02/14/2013 | |
** 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. |