-----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, AnmPrksugb3s1WfdyyEKa7lSAwXUG2qjUpbpAjZ+k8K2EKZBEg75HNF99zZrgjNT M8FBZkvX1m598nqb/eyRZg== 0001224121-05-000004.txt : 20050322 0001224121-05-000004.hdr.sgml : 20050322 20050322171406 ACCESSION NUMBER: 0001224121-05-000004 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050317 FILED AS OF DATE: 20050322 DATE AS OF CHANGE: 20050322 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: 7852335171 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PAVELKA DARREL J CENTRAL INDEX KEY: 0001224121 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-14770 FILM NUMBER: 05697340 BUSINESS ADDRESS: STREET 1: 3231 SE SIXTH AVENUE CITY: TOPEKA STATE: KS ZIP: 66607 BUSINESS PHONE: 7852952087 MAIL ADDRESS: STREET 1: 3231 SE SIXTH AVE CITY: TOPEKA STATE: KS ZIP: 66607 4/A 1 edgar.xml PRIMARY DOCUMENT X0202 4/A 2005-03-17 2005-03-18 0001060232 PAYLESS SHOESOURCE INC /DE/ PSS 0001224121 PAVELKA DARREL J 3231 S.E. SIXTH AVENUE TOPEKA KS 66607 0 1 0 0 Senior Vice President Common Stock 2005-03-17 4 M 0 4689 9.009 A 9541 D Common Stock 2005-03-17 4 M 0 2250 9.75 A 11791 D Common Stock 2005-03-17 4 S 0 5600 14.88 D 6191 D Common Stock 2005-03-17 4 S 0 1339 14.93 D 4852 D Employee Stock Option 9.009 2005-03-17 4 M 0 4689 D 2006-05-04 Common Stock 4689 0 D Employee Stock Option 9.75 2005-03-17 4 M 0 2250 D 2006-05-08 Common Stock 2250 0 D Includes approximately 700 shares are held under the Payless ShoeSource, Inc. Stock Ownership Plan. The grant of an option on of common stock under the Payless ShoeSource, Inc. 1996 Stock Incentive Plan (the "Plan"), which provides for tax withholding rights, in a transaction exempt under old Rule 16b-3. The option became exercisable as to as to 1/4 of the shares on May 4 in each of 1997, 1998, 1999 and 2000 The grant of an option on of common stock under the Payless ShoeSource, Inc. 1996 Stock Incentive Plan (the "Plan"), which provides for tax withholding rights, in a transaction exempt under old Rule 16b-3. The option became exercisable as to as to 1/4 of the shares on May 8 in each of 1997, 1998, 1999 and 2000. On March 18, 2005, the Form 4 was filed which mistakenly inidicated the transaction date as March 5, 2005. The correct transaction date is March 17, 2005. Darrel J. Pavelka 2005-03-22 -----END PRIVACY-ENHANCED MESSAGE-----