-----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, QwuWXh/UI12XC+FaVjYGNOlSFaFGNRZoc+hbYIZCZBuom0FLLQYBHTr+t3HeZ8Y3 ZMzVap9TwgTt38BJ/b1gJA== 0001224121-06-000003.txt : 20060602 0001224121-06-000003.hdr.sgml : 20060602 20060602173505 ACCESSION NUMBER: 0001224121-06-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20060602 FILED AS OF DATE: 20060602 DATE AS OF CHANGE: 20060602 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 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14770 FILM NUMBER: 06884258 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 1 edgar.xml PRIMARY DOCUMENT X0202 4 2006-06-02 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 2006-06-02 4 M 0 7300 16.02 A 17653 D Common Stock 2006-06-02 4 S 0 7300 27.38 D 10353 D Common Stock 23085 I Shares held in 401(k) and Trust Employee Stock Option 16.0208 2006-06-02 4 M 0 7300 0 D 2010-03-10 Common Stock 7300 51200 D Includes approximately 910 shares are held under the Payless ShoeSource, Inc. Stock Ownership Plan. The reporting person holds approximately 8,554 shares indirectly under the Payless ShoeSource, Inc. 401(k) Profit Sharing Plan (the "Plan") based on a statement provided by the Plan Administrator. Because the Common Stock Fund under the Plan holds both cash and Payless Common Stock, the actual number of shares allocable to each participant's accounts varies from statement to statement. 14,531 shares held in Trust in Spouse's Name Grant of an option to buy 58,500 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 option fully vested on March 10, 2005. Darrel J. Pavelka 2006-06-02 -----END PRIVACY-ENHANCED MESSAGE-----