-----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, Eut/dnGzgYkaIBDo3zcpb4l72wl3wrMOvB1B8Q8zEostCbqWCSjJc/ZtfbIbVzut Ve/0JYcAmCw9EW5rc43k8A== 0001179110-06-022845.txt : 20061205 0001179110-06-022845.hdr.sgml : 20061205 20061205174013 ACCESSION NUMBER: 0001179110-06-022845 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20061201 FILED AS OF DATE: 20061205 DATE AS OF CHANGE: 20061205 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: USANA HEALTH SCIENCES INC CENTRAL INDEX KEY: 0000896264 STANDARD INDUSTRIAL CLASSIFICATION: MEDICINAL CHEMICALS & BOTANICAL PRODUCTS [2833] IRS NUMBER: 870500306 STATE OF INCORPORATION: UT FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3838 WEST PARKWAY BLVD. CITY: SALT LAKE CITY STATE: UT ZIP: 84120-6336 BUSINESS PHONE: 8019547100 MAIL ADDRESS: STREET 1: 3838 WEST PARKWAY BLVD. STREET 2: 3838 WEST PARKWAY BLVD. CITY: SALT LAKE CITY STATE: UT ZIP: 84120-6336 FORMER COMPANY: FORMER CONFORMED NAME: USANA INC DATE OF NAME CHANGE: 19930125 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WENTZ DAVE CENTRAL INDEX KEY: 0001203343 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21116 FILM NUMBER: 061258439 MAIL ADDRESS: STREET 1: 308 W 300 STREET 2: S #203 CITY: SALT LAKE CITY STATE: UT ZIP: 84101 4 1 edgar.xml FORM 4 - X0202 4 2006-12-01 0 0000896264 USANA HEALTH SCIENCES INC USNA 0001203343 WENTZ DAVE 3838 WEST PARKWAY BLVD SALT LAKE CITY UT 84120 0 1 0 0 President Prepaid variable forward contract 2006-12-01 4 J 0 50000 D Common Stock 50000 50000 D On December 1, 2006, Dave Wentz entered into a prepaid variable forward contract (the "Contract") with an unaffiliated third party buyer (the "Buyer"). Pursuant to the Contract, Mr. Wentz has pledged 50,000 shares of common stock of USANA Health Sciences, Inc. to secure his obligation to deliver up to 50,000 shares of common stock on March 31, 2009 (the "Valuation Date"). In exchange, Mr. Wentz will receive $1,673,399, representing 69.58% of the value of the shares on the contract date. (continuation of prior footnote) The actual number of shares Mr. Wentz is obligated to deliver in 2009 varies based on the closing price (the "Final Price") of the common stock on the Valuation Date, as follows: (i) if the Final Price is at or above $68.0856 per share (the "Cap Price"), Mr. Wentz is obligated to deliver a number of shares determined by reference to a formula specified in the Contract, (ii) if the Final Price is between $38.48 per share (the "Floor Price") and the Cap Price, Mr. Wentz is obligated to deliver a number of shares determined by reference to a formula specified in the Contract and (iii) if the Final Price is at or below the Floor Price, Mr. Wentz is obligated to deliver 50,000 shares. At Mr. Wentz' option, he may deliver cash in an amount equal to the value of the required number of shares of common stock to be delivered on the Valuation Date. David A. Wentz 2006-12-05 -----END PRIVACY-ENHANCED MESSAGE-----