-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, LoFENMikpUOy+ju++v+R2vJZL2stZI85H5ItQcUnl3maE5jWjZGxAQWRiE+jBs+x J8upBASkq90N/DEnZf7i8g== 0001224121-03-000005.txt : 20030527 0001224121-03-000005.hdr.sgml : 20030526 20030527145150 ACCESSION NUMBER: 0001224121-03-000005 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030523 FILED AS OF DATE: 20030527 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PAVELKA DARREL J CENTRAL INDEX KEY: 0001224121 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14770 FILM NUMBER: 03719808 BUSINESS ADDRESS: STREET 1: 3231 SE SIXTH AVENUE CITY: TOPEKA STATE: KS ZIP: 66607 BUSINESS PHONE: 7852952087 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PAYLESS SHOESOURCE INC /DE/ CENTRAL INDEX KEY: 0001060232 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-SHOE STORES [5661] IRS NUMBER: 431813160 STATE OF INCORPORATION: DE FISCAL YEAR END: 0130 BUSINESS ADDRESS: STREET 1: 3231 SOUTH EAST SIXTH STREET CITY: TOPEKA STATE: KS ZIP: 66607-2207 BUSINESS PHONE: 9132335171 MAIL ADDRESS: STREET 1: 3231 S E 6TH ST CITY: TOPEKA STATE: KS ZIP: 66607-2207 FORMER COMPANY: FORMER CONFORMED NAME: PAYLESS SHOESOURCE HOLDINGS INC DATE OF NAME CHANGE: 19980421 4 1 edgar.xml PRIMARY DOCUMENT X0101 42003-05-23 0001060232 PAYLESS SHOESOURCE INC /DE/ PSS 0001224121 PAVELKA DARREL J 0100Senior Vice PresidentCommon Stock2003-05-234A015000A16679D< /natureOfOwnership>Employee Stock Option14.472003-05-234A065000A2004-05-232013-05-23Common Stock65006500DIncludes approximately 485 shares are held under the Payless ShoeSource, Inc. Stock Ownership Plan. The reporting person holds 10,987 shares indirectly of which 2,188 shares are held in spouse's name and approximately 8,799 are held under the Payless ShoeSource, Inc. 401(k) Plan (the &quot;Plan&quot;) based on a statement provided by the Plan Administrator. Because the Payless Common Stock Fund under the Plan holds both cash and Payless Common Stock, the actual number of shares allocable to each participant's account varies from statement to statement.Grant of an option to buy 6,500 shares of common stock under the Payless ShoeSource, Inc. 1996 Stock Incentive Plan which provides for tax withholding rights in a transaction exempt under Rule 16b-3. The options vest in three equal installments on each of the first three anniversaries of the grant.Darrel J. Pavelka2003-05-23 -----END PRIVACY-ENHANCED MESSAGE-----