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