0001179110-13-001928.txt : 20130205 0001179110-13-001928.hdr.sgml : 20130205 20130205164853 ACCESSION NUMBER: 0001179110-13-001928 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121229 FILED AS OF DATE: 20130205 DATE AS OF CHANGE: 20130205 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BARRETT WILLIAM J CENTRAL INDEX KEY: 0000923415 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08183 FILM NUMBER: 13574665 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 - X0306 5 2012-12-29 0 0 0 0000350846 SUPREME INDUSTRIES INC STS 0000923415 BARRETT WILLIAM J P O BOX 6199 FAIR HAVEN NJ 07704 1 1 1 0 Exec V P and Secretary Class A Common Stock 2012-12-24 5 J 0 170000 D 555176 D Class A Common Stock 170000 I By Grantor Trust Class A Common Stock 109942 I By Spouse Class B Common Stock 843808 D Class B Common Stock 16054 I By Spouse Incentive Stock Option 7.17 2013-05-03 Class A Common Stock 32436 32436 D Incentive Stock Option (reload) 6.36 2014-04-29 Class A Commmon Stock 31968 31968 D Incentive Stock Option (reload) 5.34 2015-05-07 Class A Common Stock 33641 33641 D Incentive Stock Option 1.71 2016-06-25 Class A Common Stock 15000 15000 D Incentive Stock Option 2.45 2017-09-30 Class A Common Stock 30000 30000 D Reporting person disclaims benefical ownership of shares owned by wife. Currently exercisble. Not applicable. On December 24, 2012, reporting person contributed 170,000 shares of STS Class A Common Stock which is owned by a grantor trust of which the reporting person is the trustee and of which the reporting person and spouse are beneficiaries. The reporting person continues to report beneficial ownership of all STS Class A Common Stock held by the grantor trust, but disclaims beneficial ownership except to the extent of his and his spouse's pecuniary interest therein. William J. Barrett 2013-02-05