4 1 a86560e4.htm FORM 4 Pacific Sunwear of California Inc.
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 4

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 this box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).

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)
  Womack, Carl
(Last) (First) (Middle)
  Pacific Sunwear of California Inc. (PSUN)
 
     
  3450 East Miraloma Ave

(Street)
4. Statement for Month/Day/Year 5. If Amendment, Date of Original (Month/Day/Year)
    12/16/2002
 
     
    6. Relationship of Reporting Person(s)
to Issuer
(Check All Applicable)
7. Individual or Joint/Group Filing
(Check Applicable Line)
  Anaheim, CA 92806-2101
(City)        (State)        (Zip)
  o  Director o  10% Owner   x Form Filed by One Reporting Person
    x  Officer (give title below)   o Form Filed by More than One Reporting Person
    o  Other (specify below)  
      Officer CFO
     

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 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 Sec-
urities Beneficially
Owned Following
Reported Trans-
action(s)

(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)

(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

              Code V   Amount (A)
or
(D)
Price          

  Common Stock   12/13/02     J     200(1)   D       57,866     D  

                         

                         

                         

                         

                         

                         

                         

                         

                         

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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)

                      Code V   (A) (D)

  Incentive Stock Option (right to buy)     $14.8333          

  Incentive Stock Option (right to buy)     $15.0420          

  Incentive Stock Option (right to buy)     $16.9800          

  Incentive Stock Option (right to buy)     $21.3500          

  Incentive Stock Option (right to buy)     $23.8130          

  Incentive Stock Option (right to buy)     $25.8130          

  Non-Qualified Stock Option (right to buy)     $6.1852          

  Non-Qualified Stock Option (right to buy)     $11.7222          

  Non-Qualified Stock Option (right to buy)     $14.8333          

  Non-Qualified Stock Option (right to buy)     $15.0420          

  Non-Qualified Stock Option (right to buy)     $16.9800          

  Non-Qualified Stock Option (right to buy)     $21.3500          

  Non-Qualified Stock Option (right to buy)     $23.8130          

  Non-Qualified Stock Option (right to buy)     $25.8130          

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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 Following
Reported Transaction(s)

(Instr. 4)
10. Ownership Form 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
                       

  09/08/08   Common Stock 26,552           26,552     D  

  01/20/09   Common Stock 641           641     D  

  08/07/11   Common Stock 5,256           5,256     D  

  02/04/12   Common Stock 1,042           1,042     D  

  09/17/09   Common Stock 4,050           4,050     D  

  01/03/11   Common Stock 4,291           4,291     D  

  12/17/06   Common Stock 1,406           1,406     D  

  10/27/07   Common Stock 50,625           50,625     D  

  09/08/08   Common Stock 7,199           7,199     D  

  01/20/09   Common Stock 10,610           10,610     D  

  08/07/11   Common Stock 29,744           29,744     D  

  02/04/12   Common Stock 23,958           23,958     D  

  09/17/09   Common Stock 45,950           45,950     D  

  01/03/11   Common Stock 15,709           15,709     D  

Explanation of Responses:

(1)   Charitable donation
With regard to the above listed Derivative Securities, options covering 25% of the shares granted become exercisable 1 year after the date granted. The remaining 75% of the shares granted become exercisable on a monthly basis over the following 3 years.

/s/ Carl Womack   12/16/02

**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 is insufficient, see Instruction 6 for procedure.

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