FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
SCOTTS LIQUID GOLD INC [ slgd ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 11/07/2003 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 11/07/2003 | P | 35,000 | A | $0.58 | 358,990 | D | |||
Common Stock | 25,890 | I(1) | By Spouse | |||||||
Common Stock | 28,890 | I(1) | By Minor Daughter | |||||||
Common Stock | 28,890 | I(1) | By Minor Son | |||||||
Common Stock | 18,222 | I(1) | By Minor Son | |||||||
Common Stock | 97,346 | I(2) | By ESOP | |||||||
Common Stock | 524,932 | I(3)(4) | By Partnership | |||||||
Common Stock | 500,132 | I(3)(5) | By Partnership and Trust | |||||||
Common Stock | 122,541 | I(1)(3)(6) | By Minor Children |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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) | 7. Title and Amount of Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Incentive Stock Option (right to buy) | $1.8562 | 11/24/1998 | 11/23/2003 | Common Stock | 50,000 | 50,000 | D | ||||||||
Incentive Stock Option (right to buy) | $1.72 | 01/11/1999 | 01/10/2004 | Common Stock | 20,500 | 20,500 | D | ||||||||
Incentive Stock Option (right to buy) | $0.7557 | 12/04/2000 | 12/03/2005 | Common Stock | 50,000 | 50,000 | D |
Explanation of Responses: |
1. The reporting person disclaims beneficial ownership of all shares held by spouse or minor children, and this report should not be deemed to be an admission that the reporting person is a beneficial owner of such shares for purposes of Section 16 or for any other purposes. |
2. Shares allocated to the account of Mr. Mark E. Goldstein under an Employee Stock Ownersip Plan as of December 31, 2002. |
3. Mark Goldstein may be deemed to be a beneficial owner of shares held by the Goldstein Family Partnership, Ltd. (the "Partnership"), for which the Goldstein Family Corporation is the general partner. |
4. These 524,932 shares are held by the Partnership and represent a portion of the total shares of common stock of Scott's Liquid Gold-Inc. (the "Company") held by the Partnership, based upon Mark E. Goldstein's and the Goldstein Family Corporation's share of any profits of the Partnership. The Goldstein Family Corporation is the sole general parnter of the Partnership. The reporting person disclaims beneficial ownership of all shares held by the Partnership, and this report shall not be deemed to be an admission that the reporting person is a beneficial owner of such shares for the purposes of Section 16 or for any other purposes. |
5. These 500,132 shares are held by the Partnership and represent a portion of the total shares of the common stock of the Company held by the Partnership, based upon a share of any profits of the Partnership, held by a charitable remainder trust of which Mark E. Goldstein is the trustee and a beneficiary. The reporting person disclaims beneficial ownership of all shares held by the Partnership, and this report shall not be deemed to be an admission that the reporting person is a beneficial owner of such shares for purposes of Section 16 or for any other purposes. |
6. These shares are held by the Partnership and represent a portion of the total shares of common stock of the Company, held by the Partnership, based upon a share of any profits of the Partnership held by Mark E. Goldstein as a custodian for minor children. The reporting person disclaims beneficial ownership of all shares held by the Partnership, and this report shall not be deemed to be an admission that the reporting person is a beneficial owner of such shares for purposes of Section 16 or for any other purposes. |
Mark E. Goldstein | 11/10/2003 | |
** 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 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. | ||
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. |