-----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, VrMb3q0S4oegfNL5YdW2bd/g73mxZaSn1mtQ9ZEVKpgE1MeQlSQEqHWF0vWtrUrx oiEeN0S+vRjNaP0F3AaZeg== 0000768835-04-000039.txt : 20040913 0000768835-04-000039.hdr.sgml : 20040913 20040913125939 ACCESSION NUMBER: 0000768835-04-000039 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040909 FILED AS OF DATE: 20040913 DATE AS OF CHANGE: 20040913 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KOLLAT DAVID T CENTRAL INDEX KEY: 0001015790 STANDARD INDUSTRIAL CLASSIFICATION: FOOTWEAR, (NO RUBBER) [3140] STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08897 FILM NUMBER: 041027053 BUSINESS ADDRESS: STREET 1: C/O 22, INC. STREET 2: 4410 SMOTHERS ROAD CITY: WESTERVILLE STATE: OH ZIP: 43081 BUSINESS PHONE: 6145230041 MAIL ADDRESS: STREET 1: 9341 COURTLAND DR CITY: ROCKFORD STATE: MI ZIP: 49351 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BIG LOTS INC CENTRAL INDEX KEY: 0000768835 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-VARIETY STORES [5331] IRS NUMBER: 061119097 STATE OF INCORPORATION: OH FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 300 PHILLIPI ROAD STREET 2: P.O.BOX 28512 CITY: COLUMBUS STATE: OH ZIP: 43228-0512 BUSINESS PHONE: 614-278-6800 MAIL ADDRESS: STREET 1: 300 PHILLIPI ROAD STREET 2: P.O.BOX 28512 CITY: COLUMBUS STATE: OH ZIP: 43228-0512 4 1 edgar.xml PRIMARY DOCUMENT X0202 4 2004-09-09 0000768835 BIG LOTS INC BLI 0001015790 KOLLAT DAVID T 4410 SMOTHERS ROAD WESTERVILLE OH 43081 1 0 0 0 Stock Purchase Option 12.17 2004-09-09 4 A 0 10000 0 A 2005-09-09 2014-10-09 Common Stock 10000 70626 D Dates in this column reflect the first of three annual vesting dates upon which 20%, 40% and 40%, respectively, of the Stock Purchase Option becomes exercisable. Option issued under Director Stock Option Plan. 11 Stock Purchase Options representing 70,626 underlying shares of Common Stock. Charles W. Haubiel II, attorney in fact for David T. Kollat 2004-09-13 -----END PRIVACY-ENHANCED MESSAGE-----