-----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, JrelM1yVn3raHcgUmwMPE2Kjr7sTy5pcbZYvN57uhbe8tcuTKLEb1TDiVLw7WL4B LlQQGwZYIFxbuNn1am+AKQ== 0000899078-03-000094.txt : 20030213 0000899078-03-000094.hdr.sgml : 20030213 20030213115808 ACCESSION NUMBER: 0000899078-03-000094 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030213 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: STEINBERG MICHAEL CENTRAL INDEX KEY: 0001185102 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 2280 N. GREENVILLE AVE. CITY: RICHARDSON STATE: TX ZIP: 75082 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FOSSIL INC CENTRAL INDEX KEY: 0000883569 STANDARD INDUSTRIAL CLASSIFICATION: WATCHES, CLOCKS, CLOCKWORK OPERATED DEVICES/PARTS [3873] IRS NUMBER: 752018505 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19848 FILM NUMBER: 03557466 BUSINESS ADDRESS: STREET 1: 2280 NORTH GREENVILLE AVE CITY: RICHARDSON STATE: TX ZIP: 75082 BUSINESS PHONE: 9722342525 MAIL ADDRESS: STREET 1: 2280 N GREENVILLE CITY: RICHARDSON STATE: TX ZIP: 75082 5 1 dec2002form5.txt FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 [ ] Check this box if no longer subject ---------------------------- to Section 16. OMB APPROVAL Form 4 or Form 5 ---------------------------- obligations may OMB Number: 3325-0362 continue. See Expires: Januiary 31, 2005 instruction 1(b) Estimated average burden [ ] Form 3 Holdings hours per response . . . 1.0 Reported ---------------------------- [X] Form 4 Filed pursuant to Section 16(a) of the Securities Trans- Exchange Act of 1934, Section 17(a) of the Public actions Utility Holding Company Act of 1935 or Reported Section 30(f) of the Investment Company Act 1940 - -------------------------------------------------------------------------------- 1.Name and Address of 2.Issuer Name and Ticker 6.Relationship of Reporting Reporting Person* or Trading Symbol Person to Issuer (check all Applicable) Fossil Inc. (FOSL)
Steinberg Michael December 2002 X Director 10% Owner - --------------------------------------- ----------------------- ----------------- --- --- (Last) (First) (MI) 3.IRS or Soc.Sec.No. 4.Statement for Officer Other of Reporting Person Month/Year --- --- (Voluntary) (give title below) (specify below) 2280 N. Greenville - --------------------------------------------------------- ---------------- ------------------------------------ (Street) 5. If Amendment, Date of Original 7.Individual or Joint/Group (Month/Year) Filing (Check Applicable Richardson TX 75082 Line) - -------------------------------------------------------- (City) (State) (Zip) 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 2. Transaction 2A. Deemed 3. Transaction 4. Security Acquired (A) (Inst.3) Date Execu- Code or Disposed of (D) (Month/ tion (Instr.8) (Inst.3, 4 & 5) Day/Yr) Date, --------------------------------------------------- if any (A) (Month/ Amount (D) Price Day/ Year) Common Stock 10/15/98 P4 4,500 A $11.817 - ------------------------------------ -------------- --------- ------- ---------------- ---- --------- Common Stock 6/12/02 G4 4,500 D (1) - ------------------------------------ -------------- --------- ------- ---------------- ---- --------- - ------------------------------------ -------------- --------- ------- ---------------- ---- --------- - ------------------------------------ -------------- --------- ------- ---------------- ---- --------- - ------------------------------------ -------------- --------- ------- ---------------- ---- ---------
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5. Amount of Securities 6. Ownership Form 7. Nature of Indirect Beneficially Owned at Direct (D) or Beneficial Ownership at End Issuer's Fiscal Indirect (I) (Inst. 4) Year (Inst. 3 & 4) 0 D - --------------------------------------- ------------------------------ ----------------------------- 0 D - --------------------------------------- ------------------------------ ----------------------------- - --------------------------------------- ------------------------------ ----------------------------- - --------------------------------------- ------------------------------ ----------------------------- - --------------------------------------- ------------------------------ -----------------------------
*If form is filed by more than one reporting person, see Instruction 4(b)(v) Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. Page 2 of 4
- -------------------------------------------------------------------------------- Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible security) - -------------------------------------------------------------------------------- 1. Title of 2. Conversion 3. Transaction 3A. Deemed 4. Transaction Derivative or Exercise Date (Month Execu- Code Security Price of (Day/Year) tion (Instr. 8) (Instr.3) Derivative Date, if Security any (Month/ Day/ Year) - ------------------------------------ ------------ ---------------- ---------- --------------- - ------------------------------------ ------------ ---------------- ---------- --------------- - ------------------------------------ ------------ ---------------- ---------- --------------- - ------------------------------------ ------------ ---------------- ---------- --------------- - ------------------------------------ ------------ ---------------- ---------- ---------------
5. Number of Derivative 6. Date Exercisable 7. Title & Amount of Securities Acquired & Expiration Date Underlying Securities (A) or Disposed of (D) (Mon./Day/Year) (Inst. 3 & 4) (Instr. 3, 4 & 5) - ------------------------------------------------------------------------------------------------------------------- (A) (D) Date Expiration Title Amount or number Exercisable Date of Shares - ----------------- ----------------- ------------ -------------- -------------- ----------------- - ----------------- ----------------- ------------ ------------- -------------- ----------------- - ----------------- ----------------- ------------ ------------- -------------- ----------------- - ----------------- ----------------- ------------ ------------- -------------- ----------------- - ----------------- ----------------- ------------ ------------- -------------- -----------------
8. Price of Derivative 9. Number of Derivative Securities 10. Ownership Form of 11. Nature of Indirect Security (Inst.5) Beneficially Owned at end of Derivative Security Beneficial Month (Instr. 4) Direct (D) or Ownership (Instr.4) Indirect (I) (Instr.4) - ----------------------- ----------------------------------- -------------------------- ------------------------ - ----------------------- ----------------------------------- -------------------------- ------------------------ - ----------------------- ----------------------------------- -------------------------- ------------------------ - ----------------------- ----------------------------------- -------------------------- ------------------------ - ----------------------- ----------------------------------- -------------------------- ------------------------ Explanation of Responses: (1) Bona fide gift for no consideration of any kind.
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/s/ Michael Steinberg 2/13/03 **Intentional misstatements or omissions of facts constitute Federal ------------------------------------------ Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date
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