0001140361-12-008799.txt : 20120215 0001140361-12-008799.hdr.sgml : 20120215 20120215182302 ACCESSION NUMBER: 0001140361-12-008799 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110504 FILED AS OF DATE: 20120215 DATE AS OF CHANGE: 20120215 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Paisner Harold M CENTRAL INDEX KEY: 0001390810 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33994 FILM NUMBER: 12617151 MAIL ADDRESS: STREET 1: BERWIN LEIGHTON PAISNER, ADELAIDE HOUSE STREET 2: LONDON BRIDGE CITY: LONDON STATE: X0 ZIP: EC4R 9HA FORMER NAME: FORMER CONFORMED NAME: Paisner Harold DATE OF NAME CHANGE: 20070222 ISSUER: 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: 0317 BUSINESS ADDRESS: STREET 1: 2859 PACES FERRY RD STREET 2: STE 2000 CITY: ATLANTA STATE: GA ZIP: 30339 BUSINESS PHONE: 7704376800 MAIL ADDRESS: STREET 1: 2859 PACES FERRY RD STREET 2: STE 2000 CITY: ATLANTA STATE: 2Q ZIP: 30339 FORMER COMPANY: FORMER CONFORMED NAME: INTERFACE FLOORING SYSTEMS INC DATE OF NAME CHANGE: 19870817 5 1 doc1.xml FORM 5 X0304 5 2011-05-04 0 0 1 0000715787 INTERFACE INC IFSIA 0001390810 Paisner Harold M 2859 PACES FERRY ROAD SUITE 2000 ATLANTA GA 30339 1 0 0 0 Class A Common Stock 2011-05-04 4 M 0 L 5000 4.31 A 17000 D Stock Option (Right to Buy) 4.31 2011-05-04 4 M 0 L 5000 0 D 2010-01-12 2019-01-12 Class A or Class B Common Stock 5000 0 D Exercise of a derivative security exempted pursuant to Rule 16b-6(b). 50% of the option vested and became exercisable on the first anniversary of the grant date, and the remaining 50% of the option vested and became exercisable on January 12, 2011. /s/ David B. Foshee, Attorney in Fact 2012-02-13