FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 04/26/2004 |
3. Issuer Name and Ticker or Trading Symbol
PATTERSON DENTAL CO [ PDCO ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 3,842 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Options | (1) | (2) | Common Stock | 19,176 | (3) | D |
Explanation of Responses: |
1. 604 shares are exercisable on 4/30/09; 3,576 shares are exercisable on 4/29/10; 2,706 shares are exercisable on 4/29/11; and 3,491 shares are exercisable on 4/27/12. Options may become exercisable earlier if certain performance targets are achieved. 8,799 shares are exercisable as follows: 1,257 on April 26 of each year 2007 - 2013. |
2. 604 shares expire on 4/30/10; 3,576 shares expire on 4/29/11; 2,706 shares expire on 4/29/12; 3,491 shares expire on 4/27/13 and 8,799 options expire on 4/26/14. |
3. The exercise price per share of the options is as follows: 604 shares at $24.375; 3,576 shares at $30.56; 2,706 shares at $45.14; 3,491 shares at $39.93; and 8,799 shares at $77.00. |
Matthew L. Levitt, by Power of Attorney | 05/04/2004 | |
** 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 5 (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. |