-----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, UY88zpKSq9IsCIMniW60Yp352ZSWMLRzPy5h2G+kXcOKIsWtz4+wLpAG0RvIVsBv iZvglk5aYNUhLjw+S069bQ== 0000922423-01-000044.txt : 20010123 0000922423-01-000044.hdr.sgml : 20010123 ACCESSION NUMBER: 0000922423-01-000044 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010101 FILED AS OF DATE: 20010116 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FAB INDUSTRIES INC CENTRAL INDEX KEY: 0000034136 STANDARD INDUSTRIAL CLASSIFICATION: KNITTING MILLS [2250] IRS NUMBER: 132581181 STATE OF INCORPORATION: DE FISCAL YEAR END: 1130 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 001-05901 FILM NUMBER: 1509098 BUSINESS ADDRESS: STREET 1: 200 MADISON AVE CITY: NEW YORK STATE: NY ZIP: 10016 BUSINESS PHONE: 2122799000 MAIL ADDRESS: STREET 1: 200 MADISON AVE CITY: NEW YORK STATE: NY ZIP: 10016 COMPANY DATA: COMPANY CONFORMED NAME: MILLER DAVID A / CENTRAL INDEX KEY: 0001098060 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 1408 WESTWOOD CT CITY: SANDPOINT STATE: ID ZIP: 83864 BUSINESS PHONE: 2082638179 MAIL ADDRESS: STREET 1: C/O FAB INDUSTRIES STREET 2: 200 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10016 5 1 0001.txt FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |_| Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |_| Form 3 Holdings Reported |_| Form 4 Transactions Reported 1. Name and Address of Reporting Person Miller, David A. c/o Fab Industries, Inc. 200 Madison Avenue New York, New York 10016 2. Issuer Name and Ticker or Trading Symbol Fab Industries, Inc. ("FIT") 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year 01/01 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Vice President-Finance, Treasurer and Chief Financial Officer 7. Individual or Joint/Group Reporting (Check Applicable Line) (X) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person
- ----------------------------------------------------------------------------------------------------------------------------------- Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | - -----------------------------------------------------------------------------------------------------------------------------------| 1. Title of Security |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | |Transaction| or Disposed of (D) | Securities |ect | Beneficial Ownership | |Date |Code| (Instr.3,4 and 5) | Beneficially |(D)or | (Instr. 4) | | |(Ins| | A/| | Owned at |Indir | | | |tr.8) Amount | D | Price | End of Year |ect(I)| | | | | | | (Instr. 3 and 4) |(Ins | | | | | | | | tr.4)| | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Common Stock, $.20 par value |12/31/| | | | | | | | |00 | A | 234 | A | (1) | 891 | I | By ESOP | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. *If form is filed by more than one reporting person, see instruction 4(b)(v). (Over) SEC 2270(7-96) FORM 5 (continued) Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
- ----------------------------------------------------------------------------------------------------------------------------------- Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned | - -----------------------------------------------------------------------------------------------------------------------------------| 1.Title of Derivative |2.Con |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of| Security |version |Transaction rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect | |or Exer |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise Pr | |(In | red(A) or Dis |Date(Month/| (Instr. 3 and 4 |Secu |Securities |(D)|Ownership | |ice of | |str.| posed of(D) |Day/Year) | |rity |Benefi |or | | |Deriva | | 8) | (Instr.3,4 and|Date |Expir| |(Instr.|ficially |Ind| | |tive | | | 5) | |Exer-|ation| Title and Number | 5) |Owned at |ire| | |Secu | | | | |cisa-|Date | of Shares | |End of |ct | | |rity | | | A | D |ble | | | |Year |(I)| | | | | | | | | | | |(Instr. 4) |(Instr. 4) | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$27.25 |7/21/ |J(6)| |10,| (2) |4/3/ |Common Stock|10,000| | 0 | D | | (right to buy) | |00 | | |000| |06 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$13.00 |10/27/| A | 10,000 | | (3) |10/27/|Common Stock|10,000| | 10,000 | D | | (right to buy) | |99 | | | | |09 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Employee Stock Option |$11.0625|11/3/ |A(4)| 2,000 | | (5) |11/3/ |Common Stock|2,000 | | 2,000 | D | | (right to buy) | |00 | | | | |10 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------|
Explanation of Responses: (1) Represents shares allocated under the Fab Industries, Inc. Employees Stock Ownership Plan. (2) 2,000 shares became exercisable on each of 04-03-96, 04-03-97, 04-03-98, 04-03-99 and 04-03-00. (3) 2,000 shares became exercisable on 10-27-00 and will become exercisable on each of 10-27-01, 10-27-02, 10-27-03 and 10-27-04. (4) Issued to replace 2,000 shares of Employee Stock Options that expired on 11-2-00. (5) 400 shares will become exercisable on each of 11-03-01, 11-03-02, 11-03-03, 11-03-04 and 11-03-05. (6) 10,000 shares of Employee Stock Options were cancelled on 7-21-00 under the Fab Industries, Inc. 1997 Stock Incentive Plan. /s/ David A. Miller 01/12/01 ------------------------------- -------- **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. -2- -----END PRIVACY-ENHANCED MESSAGE-----