-----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, Wb9ipQv3G8/4ATkgjCbbZbcp/tGhs9TuT8dQcyBXhPxFPUZljAdiKu/mtCUpq1fL 3yederK/ZwJim9u9TjmebQ== 0001140361-09-018092.txt : 20090806 0001140361-09-018092.hdr.sgml : 20090806 20090806162042 ACCESSION NUMBER: 0001140361-09-018092 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: 09991955 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 4 1 doc1.xml FORM 4 X0303 4 2009-08-04 0 0000043300 GREAT ATLANTIC & PACIFIC TEA CO INC GAP 0001179653 HAUB KARL ERIVAN WARDER 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 P 0 18800 1000 A 2010-08-05 2016-08-01 Common Stock, $1 par value 3760000 18800 D Series A-T Preferred Stock 5.00 2009-08-04 4 J 0 18800 0 D 2010-08-05 2016-08-01 Common Stock, $1 par value 3760000 0 D 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 I Limited Partnership 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 was acquired for $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 contributed to Tengelmann Warenhandelsgesellschaft KG, a limited partnership organized under the laws of the Federal Republic of Germany ("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 the August 4, 2009. Each share of the Series A-T Preferred Stock is owned by Tengelmann. The reporting person expressly declares that the filing of this statement is not an admission that the reporting person is, for 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, except to the extent of the reporting person's pecuniary interest in the Series A-T Preferred Stock. * The reporting person is a citizen of the Federal Republic of Germany. Karl-Erivan Warder Haub, by Christian Wilhelm Erich Haub (Attorney-in-Fact) 2009-08-06 -----END PRIVACY-ENHANCED MESSAGE-----