-----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, VdTKRR6hiobeC4dJi14GCYo8g91wCQflait4EjZ3mEmetC71UElfjm86dWXGQzrj NdVDRzSwcp31eVvSCLRm7g== 0000910195-99-000545.txt : 19990910 0000910195-99-000545.hdr.sgml : 19990910 ACCESSION NUMBER: 0000910195-99-000545 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990831 FILED AS OF DATE: 19990909 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTERFACE INC CENTRAL INDEX KEY: 0000715787 STANDARD INDUSTRIAL CLASSIFICATION: CARPETS AND RUGS [2273] IRS NUMBER: 581451243 STATE OF INCORPORATION: GA FISCAL YEAR END: 0103 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-12016 FILM NUMBER: 99708364 BUSINESS ADDRESS: STREET 1: 2859 PACES FERRY RD STREET 2: STE 2000 CITY: ATLANTA STATE: GA ZIP: 30339 BUSINESS PHONE: 7704376800 FORMER COMPANY: FORMER CONFORMED NAME: INTERFACE FLOORING SYSTEMS INC DATE OF NAME CHANGE: 19870817 COMPANY DATA: COMPANY CONFORMED NAME: HENDRIX DANIEL T CENTRAL INDEX KEY: 0001094629 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 2859 PACES PERRY ROAD CITY: ATLANTA STATE: GA ZIP: 30339 MAIL ADDRESS: STREET 1: 2859 PACES ROAD CITY: ATLANTA STATE: GA ZIP: 30339 4 1 FORM 4 FOR DANIEL T. HENDRIX FORM 4 [ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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 _______________________________________________________________________________ 1. Name and Address of Reporting Person HENDRIX DANIEL T. - ----------------------------------------------------- (Last) (First) (Middle) 2859 Paces Ferry Road - Suite 2000 - ----------------------------------------------------- (Street) Atlanta GA 30339 - ----------------------------------------------------- (City) (State) (Zip) _______________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Interface, Inc. (IFSIA) _______________________________________________________________________________ 3. IRS or Social Security Number of Reporting Person (Voluntary) ---- _______________________________________________________________________________ 4. Statement for Month/Year August 1999 _______________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) _______________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] 10% Owner [X] Director [X] Officer (give title below) [ ] Other (specify below) Senior Vice President, CFO and Treasurer - ----------------------------------------------------- 7. Individual or Joint/Group Filing (check Applicable Line) [X] Form filed by One Reporting Person [ ] Form filed by More than One Reporting Person Page 1 FORM 4 (continued)
- ------------------------------------------------------------------------------------------------------------------------------- | TABLE I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | | - -------------------------------------------------------------------------------------------------------------------------------| 1. Title of Security |2. Trans- |3. Transac- | 4. Securities Acquired (A) | 5. Amount of | 6. Owner- | 7. Nature of | | action | tion Code | or Disposed of (D) | Securities | ship Form: | Indirect | (Instr. 3) | Date | | | Beneficially | Direct (D) | Beneficial | | | (Instr. 8) | (Instr. 3, 4 and 5) | Owned at End | or Indirect| Ownership | | (Month/ | | | of Month | (I) | | | Day/Year) |-------------|--------------------------------| | | | | | | | Amount | (A) or | Price | (Instr. 3 | (Instr. 4) | (Instr. 4) | | | Code | V | | (D) | | and 4) | | | - ----------------------|-----------|------|------|-----------|--------|-----------|---------------|-----------------------------| | | | | | | | | | | Class A Common Stock | 08/27/99 | C| | 42,260 | A | | 47,260 | D | | - -------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | - -------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | - -------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | - -------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | - -------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | - -------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | - -------------------------------------------------------------------------------------------------------------------------------| Conversion of derivative security exempted pursuant to Rule 16b-6(b). The Reporting Person converted Class B shares into Class A shares.
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. SEC 1474 (3-99) FORM 4 (continued)
TABLE II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g. puts, calls, warrants, options, convertible securities) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of| 2. Con- | 3. | 4. | 5. Number of| 6. Date Exer- | 7. Title and | 8. Price| 9. Num- | 10. Owner- | 11. | Derivative| version | Trans- | Trans- | Derivative | cisable and | Amount of Under- | of | ber of | ship Form | Nature| Security | or Exer-| action | action | Securities | Expiration | lying Securities | Deriv- | Deriva- | of Deriva- | of In-| | cise | Date | Code | Acquired (A)| Date (Month/ | | ative | tive | tive Secur-| Direct| (Instr. 3)| Price of| (Month/ | | or Disposed | Day/Year) | (Instr. 3 and 4) | Secur- | Securi- | ity Direct | Bene- | | Deriva- | Day/ | (Instr.| of (D) | | | ity | ties | (D) or In- | ficial| | tive | Year) | 8) | |-----------------------------------| | Benefic-| direct (I) | Owner-| | Security| | | (Instr. 3, | | | | | (Instr. | ially | | ship | | | | | 4 and 5) | | | | | 5) | Owned at| (Instr. 4) | | | | |--------|-------------| Date- | Expir-| | Amount or| | End of | |(Instr.| | | | | | | | Exer- | ation | Title | Number of| | Month | | 4) | | | |Code| V | (A) | (D) | cisable| Date | | Shares | | (Instr. | | | | | | | | | | | | | | | 4) | | | - -----------|---------|---------|----|---|------|------|----------------|-------|----------|---------|---------|--------------------| | | | || | | | | | | | | | | Class B | 1-for-1 |08/27/99 |C | |42,260| Immed. | |Class A| 42,260 | | 0 | | | Common Stk | | | | | | | | |Common | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Conversion of derivative security exempted pursuant to Rule 16b-6(b). The Reporting Person converted Class B shares into Class A shares.
Explanation of Responses: - --------------------------- /s/ Daniel T. Hendrix August 31, 1999 ---------------------------------------- -------------------- ** Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Page 2 -----END PRIVACY-ENHANCED MESSAGE-----