-----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, LNmf07rTpWJgUQc1dmTju0cs5rO21UgGz4KEirBBH4RJhwQlMCevsa1WBPM3dyyQ mnfhFVjemUaGlGuKt9llHA== 0000902664-00-000408.txt : 20000516 0000902664-00-000408.hdr.sgml : 20000516 ACCESSION NUMBER: 0000902664-00-000408 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000331 FILED AS OF DATE: 20000515 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MONRO MUFFLER BRAKE INC CENTRAL INDEX KEY: 0000876427 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-AUTOMOTIVE REPAIR, SERVICES & PARKING [7500] IRS NUMBER: 160838627 STATE OF INCORPORATION: NY FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-19357 FILM NUMBER: 635428 BUSINESS ADDRESS: STREET 1: 200 HOLLEDER PKWY CITY: ROCHESTER STATE: NY ZIP: 14615-3808 BUSINESS PHONE: 7166476400 COMPANY DATA: COMPANY CONFORMED NAME: SOLOMON PETER J CENTRAL INDEX KEY: 0000909061 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 767 FIFTH AVENUE STREET 2: 26TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 MAIL ADDRESS: STREET 1: 767 FIFTH AVENUE STREET 2: 26TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 5 1 - -------- ----------------------------- FORM 5 OMB APPROVAL - -------- ----------------------------- - ----- Check this box if no longer OMB Number: 3235-0287 subject to Section 16. Form 4 Expires: April 30, 1997 - ----- or Form 5 obligations may Estimated average burden continue. See Instruction 1(b). hours per response .... 1.0 ------------------------------ - ----- Form 3 Holdings Reported - ----- - ----- Form 4 Transactions Reported - ----- U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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 - - ---------------------------------------------------------------------------- 1. Name and Address of Reporting Person Solomon Peter J. - - --------------------------------------------------- (Last) (First) (Middle) 767 Fifth Avenue, 26th Floor - - ---------------------------------------------------- (Street) New York NY 10022 - - ---------------------------------------------------- (City) (State) (Zip) - - ---------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Monro Muffler Brake, Inc. (MNRO) - - ---------------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) - - ---------------------------------------------------------------------------- 4. Statement for Month/Year Fiscal 2000 - - ---------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) - - ---------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [ ] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) -------------------- - - ----------------------------------------------------------------------------
Table I-Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned - ------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) (Instr. 3) action action or Disposed of (D) Date Code (Instr. 3, 4 and 5) ------ (Instr. 8) -------------------------- (Month/ ----------- Amount (A) or Price Day/ (D) Year) - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ 5. Amount of 6. Ownership 7. Nature of Securities Form: Direct Indirect Beneficially (D) or Indirect Beneficial Owned at End (1) (Instr. 4) Ownership of Issuer's (Instr. 4) Fiscal Year (Instr. 3 and 4) - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses) SEC 2270 (3/91) FORM 5 (continued)
Table II-Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) - ------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Transac- 4. Transac- 5. Number of Security (Instr. 3) sion or tion Date tion Code Derivative Exercise (Month/ (Instr. 8) Securities Price of Day/ ------------ Acquired (A) Deriv- Year) or Disposed ative of (D) (Instr. Security 3, 4, and 5) ------------- (A) (D) - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ Non-Employee Director Stock $7.50 8/2/99 A 3,039 N/A Option (right to buy) - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ 6. Date Exer- 7. Title and Amount 8. Price of 9. Number of cisable and Ex- of Underlying Derivative Derivative piration Date Securities Security Securities (Month/Day/ (Instr. 3 and 4) (Instr. 5) Beneficially Year) ------------------- Owned at - ------------------ Amount or End of Year Date Expira- Title Number of (Instr. 4) Exer- tion Shares cisable Date - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ 8/2/99 8/1/09 Common Stock 3,039 N/A 3,039 - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ 10. Ownership 11. Nature of of Indirect Derivative Beneficial Security: Ownership Direct (D) or (Instr. 4) Indirect (I) (Instr. 4) - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ D N/A - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------
Explanation of Responses: **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. ---/s/ Peter J. Solomon 5/12/00 **Signature of Reporting Person Date Page 2 SEC 2270 (3/91) -----END PRIVACY-ENHANCED MESSAGE-----