-----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, IRprcWMe2VyhvRBcT5EjgM+LJYdxYWsGbemx/XxfH75Q7LOTmdzl/AuiSzsCsaSn 2SKmMbNSwUIM2dNBtz9ehg== 0001179110-10-001962.txt : 20100203 0001179110-10-001962.hdr.sgml : 20100203 20100203181323 ACCESSION NUMBER: 0001179110-10-001962 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091226 FILED AS OF DATE: 20100203 DATE AS OF CHANGE: 20100203 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GARDNER HERBERT M CENTRAL INDEX KEY: 0000923414 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08183 FILM NUMBER: 10571882 MAIL ADDRESS: STREET 1: P O BOX 6199 CITY: FAIR HAVEN STATE: NJ ZIP: 07704 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SUPREME INDUSTRIES INC CENTRAL INDEX KEY: 0000350846 STANDARD INDUSTRIAL CLASSIFICATION: TRUCK & BUS BODIES [3713] IRS NUMBER: 751670945 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: P O BOX 237 STREET 2: 2581 EAST KERCHER ROAD CITY: GOSHEN STATE: IN ZIP: 46528 BUSINESS PHONE: 5746423070 MAIL ADDRESS: STREET 1: P O BOX 237 STREET 2: 2581 EAST KERCHER ROAD CITY: GOSHEN STATE: IN ZIP: 46528 FORMER COMPANY: FORMER CONFORMED NAME: EXPLORATION SURVEYS INC DATE OF NAME CHANGE: 19850813 5 1 edgar.xml FORM 5 - X0303 5 2009-12-26 0 0 0 0000350846 SUPREME INDUSTRIES INC STS 0000923414 GARDNER HERBERT M P O BOX 6199 FAIR HAVEN NJ 07704 1 1 0 0 Chairman of Board and CEO Class A Common Stock 2009-12-10 5 G 0 3050 D 427282 D Class A Common Stock 10447 I By Spouse Class B Common Stock 559869 D Class B Common Stock 63349 I By Spouse Incentive Stock Option (reload) 5.60 2010-04-17 Class A Common Stock 25131 25131 D Incentive Stock Option 6.15 2012-06-05 Class A Common Stock 27030 27030 D Incentive Stock Option (reload) 8.20 2010-10-27 Class A Common Stock 11465 11465 D Incentive Stock Option 6.52 2013-05-03 Class A Common Stock 32436 32436 D Incentive Stock Option (reload) 5.78 2014-04-29 Class A Common Stock 29058 29058 D Incentive Stock Option (reload) 4.86 2015-05-07 Class A Common Stock 30582 30582 D Incentive Stock Option 1.55 2010-06-26 2016-06-26 Class A Common Stock 15000 15000 D Reporting person disclaims beneficial ownership of shares owned by wife. Currently exercisable. Not applicable. Includes 203,115 shares of Supreme Class A Common Stock owned by IRAs of reporting person. Herbert M. Gardner 2010-02-03 -----END PRIVACY-ENHANCED MESSAGE-----