FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
|
1. Name and Address of Reporting Person*
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 05/06/2004 |
3. Issuer Name and Ticker or Trading Symbol
K SWISS INC [ KSWS ] |
|||||||||||||
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
5. If Amendment, Date of Original Filed
(Month/Day/Year) |
||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Beneficially Owned | |||
---|---|---|---|
1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
---|---|---|---|---|---|---|---|
1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Options to buy Class A Common Stock | 10/06/2004 | 10/06/2009 | Class A Common Stock, Par Value $.01 | 40,000 | $0.25 | D | |
Options to buy Class A Common Stock | 02/21/2005 | 02/21/2010 | Class A Common Stock, Par Value $.01 | 2,667 | $2.53 | D | |
Options to buy Class A Common Stock | (1) | 05/18/2010 | Class A Common Stock, Par Value $.01 | 133,332 | $3.19 | D | |
Options to buy Class A Common Stock | (2) | 03/28/2011 | Class A Common Stock, Par Value $.01 | 200,000 | $6.39 | D | |
Options to buy Class A Common Stock | (3) | 07/09/2011 | Class A Common Stock, Par Value $.01 | 100,000 | $7.05 | D | |
Options to buy Class A Common Stock | (4) | 02/13/2012 | Class A Common Stock, Par Value $.01 | 12,000 | $8.56 | D | |
Options to buy Class A Common Stock | 02/01/2009 | 07/25/2012 | Class A Common Stock, Par Value $.01 | 5,000 | $8.93 | D | |
Options to buy Class A Common Stock | 02/01/2008 | 07/25/2012 | Class A Common Stock, Par Value $.01 | 5,000 | $8.93 | D | |
Options to buy Class A Common Stock | 07/25/2010 | 07/25/2013 | Class A Common Stock, Par Value $.01 | 40,000 | $17.62 | D | |
Class B Common Stock | (5) | (5) | Class A Common Stock, Par Value $.01 | 63,240 | $0.00 | I | FN(6) |
Explanation of Responses: |
1. 66,665 options vest on 5/18/04 and 66,667 options vest on 5/18/05 |
2. 66,667 options vested on 3/28/04, 66,666 options vest on 3/28/05 and 66,667 options vest on 3/28/06 |
3. 33,334 options vest on 7/9/05 and 33,333 options vest each on 7/9/06 and 7/9/07 |
4. 4,000 options vest each on 2/13/05, 2/13/06 and 2/13/07 |
5. Shares of Class B Common Stock are not registered under Section 12 of the Securities Exchange Act. The conversion of shares of Class B Common Stock into shares of Class A Common stock is exempt from Section 16(b) of the Act under Rule 16b-6(b) promulgated thereunder. These Class B shares are convertible at any time and they do not expire. |
6. Such shares are held by David Nichols as trustee of a trust for the benefit of a related individual. |
David J Nichols | 03/02/2005 | |
** Signature of Reporting Person | Date | |
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 5 (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 is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |