-----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, LKk68FK49a+bp+88PFnLohAde7wCNHY5YqOm/CKXVwAKsQI5FRdU5RkSoUXmW+MP b1Ge9mRgBPSZX5IwyLqYhw== 0001140361-09-018086.txt : 20090806 0001140361-09-018086.hdr.sgml : 20090806 20090806160258 ACCESSION NUMBER: 0001140361-09-018086 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20090804 FILED AS OF DATE: 20090806 DATE AS OF CHANGE: 20090806 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HAUB KARL ERIVAN WARDER CENTRAL INDEX KEY: 0001179653 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-04141 FILM NUMBER: 09991686 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HAUB CHRISTIAN W E CENTRAL INDEX KEY: 0001193939 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-04141 FILM NUMBER: 09991685 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HAUB ERIVAN KARL CENTRAL INDEX KEY: 0001258200 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-04141 FILM NUMBER: 09991684 MAIL ADDRESS: STREET 1: WISSOLLSTRASSE 5-43 CITY: 45478 MUELHEIM AN DER RUHR STATE: 2M ZIP: 00000 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: GREAT ATLANTIC & PACIFIC TEA CO INC CENTRAL INDEX KEY: 0000043300 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-GROCERY STORES [5411] IRS NUMBER: 131890974 STATE OF INCORPORATION: MD FISCAL YEAR END: 0228 BUSINESS ADDRESS: STREET 1: 2 PARAGON DR CITY: MONTVALE STATE: NJ ZIP: 07645 BUSINESS PHONE: 2015739700 MAIL ADDRESS: STREET 1: 2 PARAGON DRIVE CITY: MONTVALE STATE: NJ ZIP: 07645 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TENGELMANN VERWALTUNGS UND BETEILIGUNGS GMBH CENTRAL INDEX KEY: 0001179652 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-04141 FILM NUMBER: 09991687 BUSINESS ADDRESS: STREET 1: WISSOLLSTRASSE 5-43 STREET 2: 45478 MUELHEIM AN DER RUHR CITY: FEDERAL REPULIC OF GERMANY STATE: 2M ZIP: 00000 BUSINESS PHONE: 2124741250 MAIL ADDRESS: STREET 1: WISSOLLSTRASSE 5-43 CITY: 45478 MUELHEIM AN DER RUHR STATE: 2M ZIP: 00000 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TENGELMANN WARENHANDELSGESELLSCHAFT KG CENTRAL INDEX KEY: 0001039441 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-04141 FILM NUMBER: 09991688 BUSINESS ADDRESS: STREET 1: WISSOLLSTRASSE 5-43 CITY: 45478 MUELHEIM AN DER RUHR STATE: 2M ZIP: 00000 BUSINESS PHONE: 011492085806357 MAIL ADDRESS: STREET 1: 825 8TH AVE CITY: NEW YORK STATE: NY ZIP: 10019 FORMER NAME: FORMER CONFORMED NAME: TENGELMANN WARENHANDELSGESELLSCHAST DATE OF NAME CHANGE: 19970515 4 1 doc1.xml FORM 4 X0303 4 2009-08-04 0 0000043300 GREAT ATLANTIC & PACIFIC TEA CO INC GAP 0001039441 TENGELMANN WARENHANDELSGESELLSCHAFT KG WISSOLLSTRASSE 5-43 45478 MULHEIM AN DER RUHR 2M GERMANY 0 0 1 0 0001179652 TENGELMANN VERWALTUNGS UND BETEILIGUNGS GMBH WISSOLLSTRASSE 5-43 45478 MULHEIM AN DER RUHR 2M GERMANY 0 0 1 0 0001179653 HAUB KARL ERIVAN WARDER WISSOLLSTRASSE 5-43 45478 MULHEIM AN DER RUHR 2M GERMANY 0 0 1 0 0001193939 HAUB CHRISTIAN W E 2 PARAGON DRIVE MONTVALE NJ 07645 0 0 1 0 0001258200 HAUB ERIVAN KARL WISSOLLSTRASSE 5-43 45478 MULHEIM AN DER RUHR 2M GERMANY 0 0 1 0 Series A-T Preferred Stock 5.00 2009-08-04 4 J 0 60000 0 A 2010-08-05 2016-08-01 Common Stock, $1 par value 12000000 60000 D The 8% Cumulative Convertible Preferred Stock, Series A-T, without par value, due August 1, 2016 (the "Series A-T Preferred Stock"). The Series A-T Preferred Stock has a liquidation preference of $1,000 per share and each share of Series A-T Preferred Stock is initially convertible into 200 shares of Common Stock (the "Conversion Rate"), which represents a Common Stock price per share of $5.00. The Conversion Rate is subject to change. The full right, title and ownership of the Series A-T Preferred Stock was acquired pursuant to a contribution from limited partners of Tengelmann Warenhandelsgesellschaft KG, a limited partnership organized under the laws of the Federal Republic of Germany ("Tengelmann"). Erivan Karl Haub, Christian Wilhelm Erich Haub and Karl-Erivan Warder Haub expressly declare that the filing of this statement is not an admission that they are, for the purposes of Section 16 of the Securities Exchange Act of 1934, as amended, the beneficial owner of the Series A-T Preferred Stock owned by Tengelmann. The Series A-T Preferred Stock is not presently convertible into Common Stock but will become convertible on August 5, 2010, at the holder's option, subject to any limitations imposed by any stockholder approval requirements of the New York Stock Exchange. The value set forth in this field is based upon the Conversion Rate as of August 4, 2009. Karl-Ervian Warder Haub, by Christian Wilhelm Erich Haub (Attorney-in-Fact) 2009-08-06 Tengelmann Warenhandelsgesellschaft KG, by Tengelmann Verwaltungs-und Beteiligungs GmbH, as Managing Partner, by Christian Wilhelm Erich Haub, Co-CEO 2009-08-06 Christian Wilhelm Erich Haub 2009-08-06 Tenglemann Verwaltungs und Beteiligungs GMBH, by Christian Wilhelm Erich Haub, Co-CEO 2009-08-06 Erivan Karl Haub, by Christian Wilhelm Haub (Attorney-in-Fact) 2009-08-06 -----END PRIVACY-ENHANCED MESSAGE-----