-----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, JJu8xLBpnnK0qp7HEdCUAziVQFRKZNrcDwccOZy/7qFbGuJQRmCzj296zITTLQww orpIxWbMjpAzVL1o1QUAPA== 0000950134-03-002509.txt : 20030214 0000950134-03-002509.hdr.sgml : 20030214 20030214081258 ACCESSION NUMBER: 0000950134-03-002509 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030214 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: MICALLEF ALFRED N CENTRAL INDEX KEY: 0001201947 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: JMK INTERNATIONAL INC STREET 2: 4800 BRYANT IRVIN CT CITY: FORT WORTH STATE: TX ZIP: 76107 BUSINESS PHONE: 8177373703 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CASH AMERICA INTERNATIONAL INC CENTRAL INDEX KEY: 0000807884 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-MISCELLANEOUS RETAIL [5900] IRS NUMBER: 752018239 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09733 FILM NUMBER: 03562476 BUSINESS ADDRESS: STREET 1: 1600 W 7TH ST CITY: FT WORTH STATE: TX ZIP: 76102 BUSINESS PHONE: 8173351100 MAIL ADDRESS: STREET 1: 1600 WEST 7TH STREET CITY: FORT WORTH STATE: TX ZIP: 76102 FORMER COMPANY: FORMER CONFORMED NAME: CASH AMERICA INVESTMENTS INC /TX/ DATE OF NAME CHANGE: 19920520 5 1 d03108ue5.htm FORM 5 e5
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 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(h) of the Investment Company Act of 1940

o Check box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
o Form 3 Holdings Reported
o Form 4 Transactions Reported
1. Name and Address of Reporting
Person*		 2. Issuer Name and Ticker or Trading
Symbol		 3. I.R.S. Identification Number of Reporting
Person, if an entity (Voluntary)
  Micallef, Alfred M.
(Last) (First) (Middle)		   Cash America International, Inc. (PWN)
 
   
                 
 
4800 Bryan Irvin Court
4. Statement for Month/Year 5. If Amendment, Date of Original (Month/Year)
    2002
 
  (Street) 6. Relationship of Reporting Person(s)
to Issuer (Check All Applicable)		 7. Individual or Joint/Group Reporting
(Check Applicable Line)
  Fort Worth, TX 76107
(City)        (State)        (Zip)		   x  Director o  10% Owner   x Form filed by One Reporting Person
    o  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)  
     
     
*   If the form is filed by more than one reporting person, see instruction 4(b)(v).

 

                                     
Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of
Security
(Instr. 3)		 2. Transaction
Date
(Month/Day/Year)		 2A. Deemed Execution
Date, if any
(Month/Day/Year)		 3. Transaction
Code
(Instr. 8)		 4. Securities Acquired (A)
or Disposed of (D)
(Instr. 3, 4 and 5)		 5. Amount of Securities
Beneficially Owned
at the End of Issuer's
Fiscal Year
(Instr. 3 and 4)		 6. Ownership
Form:
Direct (D) or
Indirect (I)
(Instr. 4)		 7. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
                    Amount (A)
or
(D)		 Price            
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     

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Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative
Security
(Instr. 3)		 2. Conversion or Exercise
Price of Derivative
Security		 3. Transaction Date
(Month/Day/Year)		 3A. Deemed Execution
Date, if any
(Month/Day/Year)		 4. Transaction Code
(Instr. 8)		 5. Number of Derivative Securities
Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
                            (A) (D)
  Stock Options (right to buy)     $8.72     4/24/02     A   2,500
               
               
               
               
               
               
               
               
               

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Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)
6. Date Exercisable and
Expiration Date
(Month/Day/Year)		 7. Title and Amount of
Underlying Securities
(Instr. 3 and 4)		 8. Price of Derivative
Security
(Instr. 5)		 9. Number of Derivative
Securities Beneficially
Owned at End of
Year
(Instr. 4)		 10. Ownership of
Derivative Security:
Direct (D)
or Indirect (I)
(Instr. 4)		 11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
  Date
Exercisable		 Expiration
Date		   Title Amount or
Number of
Shares		                        
  4/23/03 4/24/12   Common Stock 2,500           12,500     D  
                   
                   
                   
                   
                   
                   
                   
                   
                   

Explanation of Responses:

/s/ Alfred M. Micallef   2-10-03
**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).
 
Note:   File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure.

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