-----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, NIw25GjAuPM6yZHSn9/Bz4z4jiK5q0phf2igWgxFWre4SXCLUeOR2b1QnuOYEPya HO9wzB+iOMeQUx+GnxlBaw== 0000902664-01-500144.txt : 20010516 0000902664-01-500144.hdr.sgml : 20010516 ACCESSION NUMBER: 0000902664-01-500144 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010331 FILED AS OF DATE: 20010515 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: 1634521 BUSINESS ADDRESS: STREET 1: 200 HOLLEDER PKWY CITY: ROCHESTER STATE: NY ZIP: 14615-3808 BUSINESS PHONE: 7166476400 COMPANY DATA: COMPANY CONFORMED NAME: GLICKMAN DONALD CENTRAL INDEX KEY: 0000901114 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 450 PARK AVENUE STREET 2: 5TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10021 BUSINESS PHONE: 2123190324 MAIL ADDRESS: STREET 1: 535 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10022 5 1 srz2079307v2.txt FORM 5 - -------- ----------------------------- FORM 5 OMB APPROVAL - -------- ----------------------------- [ ] Check this box if no longer OMB Number: 3235-00362 subject to Section 16. Form 4 Expires: October 31, 2001 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* Glickman Donald - ----------------------------------------------------- (Last) (First) (Middle) 450 Park Avenue, 6th Floor - ----------------------------------------------------- (Street) New York NY 10021 - ----------------------------------------------------- (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 2001 - ---------------------------------------------------------------------------- 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 |2. Trans- | 3. Trans- | 4. Securities Acquired | 5. Amount of |6. Ownership | 7. Nature of| |Security |action |action Code|(A) or Disposed of (D) |Securities |Form: Direct (D)|Indirect | |(Instr. 3) |Date |(Instr. 8) |(Instr. 3, 4 and 5) |Beneficially |or Indirect (I) |Beneficicial | | |(Month/ | |------------------------|Owned at End |(Instr. 4) |Ownership | | |Day/Year) | | Amount |(A)/(D)| Price |of Issuer's | |(Instr. 4) | | | | | | | |Fiscal Year | | | | | | | | | |(Instr. 3 and 4)| | | |------------- |-----------|-----------|--------|-------|-------|----------------|----------------|------------ | | | | | | | | | | | |------------- |-----------|-----------|--------|-------|-------|----------------|----------------|------------ | | | | | | | | | | | |------------- |-----------|-----------|--------|-------|-------|----------------|----------------|------------ | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------
* If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). 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 |2. Conver-|3. Trans-|4. |5. Number of |6. Date |7. Title and |8. Price|9. Number |10. Owner-|Nature | |of |sion or |action |Trans- |Derivative |Exercisable and |Amount of |of |of |ship of |of | |Derivative |Exercise |Date |action |Securities |Expiration Date |Underlying |Deriv- |Derivative|Derivative|Indirect| |Security |Price of |(Month/ |Code |Acquired (A) |(Month/Day/Year)|Securities |ative |Securities|Security: |Bene- | |(Instr. 3) |Derivative|Day/Year)|(Instr.|or Disposed |----------------|(Instr. 3 and 4)|Security|Beneficia-|Direct (D)|ficial | | |Security | |8) |of (D) (Instr.|Date | Expira-|----------------|(Instr. |lly Owned | or |Owner- | | | | | |3, 4, and 5) |Exer- | tion |Title |Amount or|5) |at End |Indirect |ship | | | | | |--------------|cisable| Date | |Number of| |of Year |(I) | | | | | | |(A) |(D) | | | |Shares | |(Instr. 4)|(Instr. 4)| | |-----------|----------|---------|-------|------|-------|-------|--------|------|---------|--------|----------|----------|--------| |Non- | $9.38 | 8/07/00 | A | 3,039| N/A |8/07/00| 8/07/10|Common| 3,039 | N/A | 3,039 | D | N/A | |Employee | | | | | | | |Stock | | | | | | |Director | | | | | | | | | | | | | | |Stock | | | | | | | | | | | | | | |Option | | | | | | | | | | | | | | |(right | | | | | | | | | | | | | | |to buy) | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: /s/ Donald Glickman 5/14/01 ------------------------------- ------- 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. SEC 2270 (3/91) -----END PRIVACY-ENHANCED MESSAGE-----