5 1 kvf5bmherm.txt FORM 5 FOR MARC S. HERMELIN ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0362 Expires: February 1, 1994 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 of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [ ] Form 3 Holdings Reported [ ] Form 4 Transaction Reported ================================================================================ 1. Name and Address of Reporting Person Hermelin Marc S. -------------------------------------------------------------------------------- (Last) (First) (Middle) 2503 South Hanley Road -------------------------------------------------------------------------------- (Street) St. Louis MO 63144 -------------------------------------------------------------------------------- (City) (State) (Zip) ================================================================================ 2. Issuer Name and Ticker or Trading Symbol KV Pharmaceutical Company; KV.B ================================================================================ 3. IRS or Social Security Number of Reporting Person (Voluntary) ================================================================================ 4. Statement for Month/Year March 31, 2001 ================================================================================ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [ X ] Director [ ] 10% Owner [ X ] Officer (give title below) [ ] Other (specify below) Vice Chairman and Chief Executive Officer ================================================================================ 7. Individual or Joint/Group Reporting [ 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 Disposed of (D) Beneficially Form: 7. (Instr. 3, 4 and 5) Owned at End Direct Nature of 2. 3. ------------------------------- of Issuer's (D) or Indirect 1. Transaction Transaction (A) Fiscal Year Indirect Beneficial Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Class B Common Stock 634,510 D ------------------------------------------------------------------------------------------------------------------------------------ Class B Common Stock 1,543,077 I(a) By Trust ------------------------------------------------------------------------------------------------------------------------------------ Class B Common Stock 264,375 I(b) By Trust ------------------------------------------------------------------------------------------------------------------------------------ Class B Common Stock 2,081 I(c) By LTDPTC ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ (a) Shares held in two trusts in which the reporting person is one of three trustees of each trust; including Trust Agreement dated 12/22/73 FBO Marc S. Hermelin, in which the reporting person is the primary beneficiary, and one trust including Trust Agreement dated 12/12/73 FBO Minnette Hermelin. (b) Shares held in an Irrevocable trust for the benefit of the reporting person. The reporting person does not hold or share voting or dispositive power regarding the shares. (c) Shares held in limited partnership. ====================================================================================================================================
FORM 5 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
9. 10. Number Owner- of ship 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) ------------------------------------------------------------------------------------------------------------------------------------ Option to Class B Purchase $11.000 11/02/00 G 35,650 8/16/03 Common 35,650 39,350 D ------------------------------------------------------------------------------------------------------------------------------------ Option to Class B Purchase $14.483 11/02/00 G 32,200 6/01/03 Common 32,200 42,800 D ------------------------------------------------------------------------------------------------------------------------------------ Option to Class B Purchase Common 57,500 D ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: /s/ Marc S. Hermelin 5/15/01 --------------------------------------------- ----------------------- Signature of Reporting Person Date