-----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, VbIt5hVSHhJWAOVEt/g/4yKCH2bJqWa3VHyVsUwKOeTaQLvkUYPUTD5d3lgcqT0y joy3SdT9S8EF/PXI8Wp02Q== 0000905729-03-000046.txt : 20030206 0000905729-03-000046.hdr.sgml : 20030206 20030206152003 ACCESSION NUMBER: 0000905729-03-000046 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030116 FILED AS OF DATE: 20030206 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: STAPLES DAVID M CENTRAL INDEX KEY: 0001119398 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 850 76TH ST. SW CITY: GRAND RAPIDS STATE: MI ZIP: 49518 MAIL ADDRESS: STREET 1: 850 76TH ST SW CITY: GRAND RAPIDS STATE: MI ZIP: 49518 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SPARTAN STORES INC CENTRAL INDEX KEY: 0000877422 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-GROCERIES & GENERAL LINE [5141] IRS NUMBER: 380593940 STATE OF INCORPORATION: MI FISCAL YEAR END: 0329 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-31127 FILM NUMBER: 03542476 BUSINESS ADDRESS: STREET 1: 850 76TH ST SW STREET 2: P O BOX 8700 CITY: GRAND RAPIDS STATE: MI ZIP: 49518 BUSINESS PHONE: 6168782000 MAIL ADDRESS: STREET 1: 850 76TH ST SW STREET 2: PO BOX 8700 CITY: GRAND RAPIDS STATE: MI ZIP: 49518 4 1 staples4_020503.htm FORM 4 ON BEHALF OF DAVID M. STAPLES FORM 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE
COMMISSION
 
 
OMB APPROVAL
[  ] Check this box if no longer
      subject to Section 16. Form 4 or
      Form 5 obligations may continue.
      See Instruction 1(b).
Washington, D.C. 20549
 
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

 
  OMB Number:    3235-0287
  Expires:  January 31, 2005
  Estimated average burden
  hours per response. ... 0.5
 
 
(Print or Type Responses)
 
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
 
  1.    Name and Address of Reporting Person*                                                                                                   
Staples,                    David                  M.

   (Last)                                         (First)                                        (Middle)
  4.    Statement for Month/Day/Year
   
   
        1/16/03
 
 
 

  850 - 76th Street SW

                                                          (Street)
  5.    If Amendment, Date of Original (Month/Day/Year)
  
  

 
 
 
Grand Rapids,                  Michigan            49518
    (City)                                         (State)                                            (Zip)
 
  2.    Issuer Name and Ticker or Trading Symbol  
 
 Spartan Stores, Inc. ("SPTN")
  6.    Relationship of Reporting Person(s) to Issuer
                                    (Check all applicable)
              Director                                            10% Owner
     X         Officer (give title below)                      Other (specify below)
                           
                 
       Exec. Vice President & Chief Financial Officer      
  3.    I.R.S. Identification Number of Reporting Person, if an entity (voluntary)
 
 
  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
 
 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
     Securities
     Beneficially
     Owned
     Following
     Reported
     Transaction(s)
     (Instr. 3 and 4)
6.Ownership
   Form: Di-
   rect (D) or
   Indirect (I)
   (Instr. 4)
 7. Nature of
     Indirect
     Beneficial
     Ownership
     (Instr. 4)
      Code V Amount (A) or (D) Price      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

page 1 of 2

 
 
FORM 4 (continued) 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)
6. Date Exercisable
    and Expiration Date
    (Month/Day/Year)
         
Code
 
V
 
(A)
 
(D)
Date
Exercisable
Expiration
Date
Phantom Stock
(1)
1/16/03
  A   2,133.173
 
(1) (1)
 
 
 
       
 
   
 
 
 
       
 
   
 
 
 
       
 
   
 
 
 
       
 
   
 
 
 
       
 
   
 
 
 
       
 
   
 
 
 
       
 
   
 
 
 
       
 
   
 
 
 
       
 
   
 
 
 
       
 
   
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 Securities
      Beneficially Owned
      at End of Month
      (Instr. 4)
11. Nature of Indirect
      Beneficial Ownership
      (Instr. 4)
 Title Amount or Number of Shares        
Common Stock 2,133.173 $1.56 2,133.173 D  
           
           
           
           
           
           
           
           
           

Explanation of Responses:         

(1) This Form 4 reports the award of phantom stock pursuant to the Spartan Stores, Inc. Supplemental Executive Retirement Plan ("Plan"). Shares of phantom stock are issuable on a one-for-one basis and are payable in cash following termination of employment in accordance with the Plan.



By:    /s/ David M. Staples
  February 6, 2003
   **Signature of Reporting Person   Date
    David M. Staples    
    *By Alex J. DeYonker    
    Attorney-in-Fact    

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).
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  

page 2 of 2


LIMITED POWER OF ATTORNEY

                    The undersigned does hereby constitute and appoint ALEX J. DEYONKER and TIMOTHY L. HORNER, or any one or more of them, his or her true and lawful attorneys and agents to do any and all acts and things and to execute and file any and all instruments that such attorneys and agents, or any of them, may consider necessary or advisable to enable the undersigned (in his or her individual capacity or in a fiduciary or other capacity) to comply with the Securities Exchange Act of 1934, as amended (the "Act"), and any requirements of the Securities and Exchange Commission in respect thereof, in connection with the preparation, execution and filing of any report or statement of beneficial ownership or changes in beneficial ownership of securities of SPARTAN STORES, INC. (the "Company") that the undersigned (in his or her individual capacity or in a fiduciary or other capacity) may be required to file pursuant to Sections 13 or 16 of the Act including, without limitation, full power and authority to sign the undersigned's name, in his or her individual capacity or in a fiduciary or other capacity, to any report, application or statement on Form ID, Forms 3, 4 or 5, Schedules 13D or 13G, or to any amendments or any successor forms thereto, or any form or forms adopted by the Securities and Exchange Commission in lieu thereof or in addition thereto, hereby ratifying and confirming all that such attorneys and agents, or any of them, shall do or cause to be done by virtue hereof.

                    The undersigned agrees that the attorneys-in-fact named herein may rely entirely on information furnished orally or in writing by the undersigned to such attorneys-in-fact. The undersigned also agrees to indemnify and hold harmless the attorneys-in-fact against any losses, claims, damages or liabilities (or actions in respect thereof) that arise out of or are based upon any untrue statement or omission of necessary fact in the information provided by the undersigned to the attorneys-in-fact for purposes of executing, acknowledging, delivering or filing any such forms, or any amendments or any successor forms thereto, or any form or forms adopted by the Securities and Exchange Commission in lieu thereof or in addition thereto.

                    This authorization shall be in addition to all prior authorizations to act for the undersigned with respect to securities of the Company in these matters.


Date: July 12, 2000

/s/ David M. Staples


David M. Staples

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