0001209191-12-039046.txt : 20120725 0001209191-12-039046.hdr.sgml : 20120725 20120725163736 ACCESSION NUMBER: 0001209191-12-039046 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120724 FILED AS OF DATE: 20120725 DATE AS OF CHANGE: 20120725 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MUSSAFER DAVID M CENTRAL INDEX KEY: 0001197538 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35600 FILM NUMBER: 12979251 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE ST 29TH FLOOR CITY: BOSTON STATE: MA ZIP: 02104 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FIVE BELOW, INC CENTRAL INDEX KEY: 0001177609 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-VARIETY STORES [5331] IRS NUMBER: 000000000 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1818 MARKET STREET STREET 2: SUITE 1900 CITY: PHILADELPHIA STATE: PA ZIP: 19103 BUSINESS PHONE: 215 546 7909 MAIL ADDRESS: STREET 1: 1818 MARKET STREET STREET 2: SUITE 1900 CITY: PHILADELPHIA STATE: PA ZIP: 19103 FORMER COMPANY: FORMER CONFORMED NAME: FIVE BELOW INC DATE OF NAME CHANGE: 20030305 FORMER COMPANY: FORMER CONFORMED NAME: CHEAP HOLDINGS INC DATE OF NAME CHANGE: 20020717 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2012-07-24 0 0001177609 FIVE BELOW, INC FIVE 0001197538 MUSSAFER DAVID M C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 1 0 0 0 Common Stock 2012-07-24 4 C 0 32950 A 32950 I See Footnote Common Stock 2012-07-24 4 S 0 4155 15.81 D 28795 I See Footnote Series A 8% Convertible Preferred Stock 2012-07-24 4 D 0 95321 0.00 D Common Stock 32950 0 I See Footnote The Series A 8% Convertible Preferred Stock is convertible into Five Below, Inc. common stock on a 1-for-0.346 basis and has no expiration date. These shares are indirectly beneficially owned as a limited partner of Advent Partners GPE VI 2008 Limited Partnership, which in turn is a shareholder of Advent - Five Below Acquisition Limited Partnership, which is the direct owner of these securities. Jarlyth H. Gibson, Attorney in Fact 2012-07-24