-----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, O1dB4Fq27OGajcH5cuiIUjZyhD/oAhxuS3sH61vVs1dKSC5sR2Q14oBjwclLRCrj cnw1040Hm9003M5N6ZP3nw== 0000910680-03-000404.txt : 20030430 0000910680-03-000404.hdr.sgml : 20030430 20030430150851 ACCESSION NUMBER: 0000910680-03-000404 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030228 FILED AS OF DATE: 20030430 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: GLASS ROBERT CENTRAL INDEX KEY: 0001017606 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-WOMEN'S CLOTHING STORES [5621] RELATIONSHIP: DIRECTOR STATE OF INCORPORATION: DE FISCAL YEAR END: 0731 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: C/O LOEHMANNS HOLDINGS INC STREET 2: 2500 HALSEY ST CITY: NEW YORK STATE: NY ZIP: 10461 MAIL ADDRESS: STREET 1: C/O LOEHMANNS HOLDINGS INC STREET 2: 2500 HALSEY STREET CITY: NEW YORK STATE: NY ZIP: 10401 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: LOEHMANNS HOLDINGS INC CENTRAL INDEX KEY: 0000843081 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-WOMEN'S CLOTHING STORES [5621] IRS NUMBER: 133492628 STATE OF INCORPORATION: MD FISCAL YEAR END: 0131 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-31787 FILM NUMBER: 03672587 BUSINESS ADDRESS: STREET 1: 2500 HALSEY ST CITY: BRONX STATE: NY ZIP: 10461 BUSINESS PHONE: 7184092000 MAIL ADDRESS: STREET 1: 2500 HALSEY ST CITY: BRONX STATE: NY ZIP: 10461 5 1 form5rglass022003.txt ROBERT GLASS ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0362 Expires: January 31, 2005 Estimated average burden hours per response ....... 1.0 ------------------------------ UNITED STATES 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 box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [ ] Form 3 Holdings Reported [ ] Form 4 Transactions Reported - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Glass Robert - -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Loehmann's Holdings, Inc. 2500 Halsey Street - -------------------------------------------------------------------------------- (Street) New York NY 10461 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Loehmann's Holdings, Inc. ("LHMS") - -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Year February 2003 - -------------------------------------------------------------------------------- 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) Chief Operating Officer, Secretary, 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 - -------------------------------------------------------------------------------- ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
5. Amount of 6. Owner- 2A. 4. Securities Acquired (A) or Securities ship 7. Nature 2. Trans- Deemed 3. Trans- Disposed of (D) Beneficially Form: of action Execution action (Instr. 3, 4 and 5) Owned at End Direct Indirect Date Date, if Code -------------------------- of Issuer's (D) or Benefi- 1. Title (Month/ any Month/ (Instr.8) (A) Fiscal Indirect cial of Security Day/ Day/ or Year (Instr. (I) Ownership (Instr. 3) Year) Year) Amount (D) Price 3 and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.01 per share None - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
*If the form is filed by more than one reporting person see instruction 4(b)(v). (Over) SEC 2270 (3-99) FORM 5 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ================================================================================
10. 9. Owner- Number ship of Form 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. 3A. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- Deemed 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Execution Trans- of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date Date, if action (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ any Code 4 and 5) Date Expira- Number ity Year (I) ship Security Secur- Day/ (Month/Day (Instr. ----------- Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Option to Purchase Common Common Stock $7.75(3) 5/10/02 A 150,000(3) (1) 5/9/12 Stock 150,000(3) 150,000(3) D - ------------------------------------------------------------------------------------------------------------------------------------ Option to Purchase Common Common Stock $6.125(3) 3/25/02 A 200,000(3) (2) 3/24/12 Stock 200,000(3) 200,000(3) D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) In three equal installments of 50,000 on each of October 31, 2004, October 31, 2005 and October 31, 2006 (2) As of the date of this filing, immediately as to 150,000 and 50,000 on October 10, 2003 (3) Reflects a 2 for 1 stock split on October 15, 2002 /s/ Robert Glass 4/24/2003 - ------------------------------------------- ----------------- **Signature of Reporting Person Date * If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). ** 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. 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 number. Page 2 -----END PRIVACY-ENHANCED MESSAGE-----