-----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, KO1KPKx0w76bY6w8Ud0inOPLLN0J+1LH4iWy0vy9j17VnX4YwoZiqLxfcZoaN4Hr icJL3naewsB1sOdVbHuozg== 0000950142-02-000073.txt : 20020413 0000950142-02-000073.hdr.sgml : 20020413 ACCESSION NUMBER: 0000950142-02-000073 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020116 FILED AS OF DATE: 20020116 COMPANY DATA: COMPANY CONFORMED NAME: MYERS STEVEN CENTRAL INDEX KEY: 0001102954 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: FAB INDUSTRIES INC STREET 2: 200 MADISON AVE CITY: NEW YORK STATE: NY ZIP: 10016 MAIL ADDRESS: STREET 1: FAB INDUSTRIES INC STREET 2: 200 MADISON AVE CITY: NEW YORK STATE: NY ZIP: 10016 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: 1934 Act SEC FILE NUMBER: 001-05901 FILM NUMBER: 2510353 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 5 1 form5meyers.txt ANNUAL STMT. OF CHANGES IN BENEF. OWNERSHIP ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0362 Expires: December 31, 2001 Estimated average burden hours per response ....... 1.0 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 [_] Check this 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* Myers Steven - -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Fab Industries, Inc., 200 Madison Avenue - -------------------------------------------------------------------------------- (Street) New York NY 10016 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Fab Industries, Inc. ("FIT") ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year 01/02 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [X] Director [_] 10% Owner [X] Officer (give title below) [_] Other (specify below) President, Chief Operating Officer ________________________________________________________________________________ 7. Individual or Joint/Group Filing (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 ================================================================================
5. 6. 4. Amount of Owner- Securities Acquired (A) or Securities ship 2. 3. Disposed of (D) Beneficially Form: 7. Transaction Transaction (Instr. 3, 4 and 5) Owned at End Direct Nature of Date Code ------------------------------- of Issuer's (D) or Indirect 1. (Month/ (Instr. 8) (A) Fiscal Year Indirect Beneficial Title of Security Day/ ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) Year) Code (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $.20 par value 08/01/01 A 151 A (1) 1,624 (1) I By ESOP - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $.20 par value 48,370 (2) I By Spouse - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $.20 par value 2,000 (3) I By Child - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $.20 par value 3,332 (3) I By Child - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $.20 par value 21,532 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the form is filed by more than one reporting person, see Instruction 4(b)(v). 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 CONTROL NUMBER. (Over) SEC 2270 (3/99) FORM 5 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- Securities Date Securities Price Bene- ity: In- cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Trans- of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy) $11.0625 11/03/00 A(4) 20,000 (5) 11/03/10 Common Stock 20,000 20,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) Represents shares allocated under the Fab Industries, Inc. Employees Stock Ownership Plan. (2) Shares owned by Mr. Myers' spouse. Mr. Myers disclaims beneficial ownership of these shares. (3) Shares owned by Mr. Myers' child. Mr. Myers disclaims beneficial ownership of these shares. (4) Issued to replace shares of Employee Stock Options that expired on 11-2-00. (5) 4,000 shares become exercisable on each of 11-3-01, 11-03-02, 11-03-03, 11-03-04 and 11-03-05. /s/ Steven Myers January 8, 2002 - --------------------------------------------- ----------------------- **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 control number. Page 2 -----END PRIVACY-ENHANCED MESSAGE-----