-----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, JW079kzcU3FK3TmShqssVwZhzYfdJQUyxJaP+pXyxGwN/GwzxqXeLjkHM7cYCzD+ 2fiN3I05MjQVePm9c0446Q== 0001239145-04-000003.txt : 20041217 0001239145-04-000003.hdr.sgml : 20041217 20041217143420 ACCESSION NUMBER: 0001239145-04-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041215 FILED AS OF DATE: 20041217 DATE AS OF CHANGE: 20041217 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: COLLINS INDUSTRIES INC CENTRAL INDEX KEY: 0000021759 STANDARD INDUSTRIAL CLASSIFICATION: MOTOR VEHICLES & PASSENGER CAR BODIES [3711] IRS NUMBER: 430985160 STATE OF INCORPORATION: MO FISCAL YEAR END: 1031 BUSINESS ADDRESS: STREET 1: 15 COMPOUND DR CITY: HUTCHINSON STATE: KS ZIP: 67502 BUSINESS PHONE: 6206635551 MAIL ADDRESS: STREET 1: 15 COMPOUND DRIVE STREET 2: PO BOX 648 CITY: HUTCHINSON STATE: KS ZIP: 67502 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CLARK TERRY L CENTRAL INDEX KEY: 0001239145 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12619 FILM NUMBER: 041211010 BUSINESS ADDRESS: BUSINESS PHONE: 6205131001 MAIL ADDRESS: STREET 1: C/O COLLINS INDUSTRIES INC STREET 2: 15 COMPUND DR CITY: HUTCHINSON STATE: KS ZIP: 67502 4 1 primary_doc.xml PRIMARY DOCUMENT X0202 4 2004-12-15 0 0000021759 COLLINS INDUSTRIES INC COLL 0001239145 CLARK TERRY L C/O COLLINS INDUSTRIES INC 15 COMPUND DR HUTCHINSON KS 67502 0 1 0 0 Executive VP - Operations Collins Industries, Inc. - Common Stock 2004-12-15 4 M 0 5000 5.125 A 69676 D Collins Industries, Inc. - Common Stock 2004-12-15 4 M 0 800 4.25 A 70476 D Collins Industries, Inc. - Common Stock 2004-12-15 4 M 0 23498 4.375 A 93974 D Collins Industries, Inc. - Common Stock 2004-12-15 4 F 0 19676 6.7 D 74298 D Collins Industries, Inc. - Common Stock 2004-12-15 4 F 0 3989 6.7 D 70309 D Stock Option (Right to Buy) 5.125 2004-12-15 4 M 0 5000 5.125 D 1997-04-22 2006-11-22 Common Stock 5000 75800 D Stock Option (Right to Buy) 4.25 2004-12-15 4 M 0 800 4.25 D 1997-08-28 2007-02-28 Common Stock 800 75000 D Stock Option (Right to Buy) 4.375 2004-12-15 4 M 0 23498 4.375 D 1997-10-04 2007-04-04 Common Stock 23498 51502 D Exchange of previously held shares for payment of exercise price. Exchange of previously held shares for payment of taxes. /s/ Larry W. Sayre, Attorney in Fact for Terry L. Clark under a Limited Power of Attorney dated December 4, 1997 2004-12-15 -----END PRIVACY-ENHANCED MESSAGE-----