5 1 form5-packdyncorp_021303.txt FORM 5 - ANNUAL STATEMENT ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0362 Expires: January 31, 2005 Estimated average burden hours per response.........1.0 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 5 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(h) of the Investment Company Act of 1940 [_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [X] Form 3 Holdings Reported [_] Form 4 Transactions Reported ________________________________________________________________________________ 1. Name and Address of Reporting Person* Keystone, Inc. -------------------------------------------------------------------------------- (Last) (First) (Middle) 201 Main Street, Suite 3100 -------------------------------------------------------------------------------- (Street) Fort Worth Texas 76102 -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Packaging Dynamics Corporation (PKDY) ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year 12/31/02 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [_] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) ____________________________________________________________________ ________________________________________________________________________________ 7. Individual or Joint/Group Filing (check applicable line) [_] Form filed by One Reporting Person [X] Form filed by More than One Reporting Person ________________________________________________________________________________ ================================================================================ TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ================================================================================
5. 6. 4. Amount of Owner- Securities Acquired (A) or Securities ship 2A. 3. Disposed of (D) Beneficially Form: 7. 2. Deemed Transaction (Instr. 3, 4 and 5) Owned Direct Nature of Trans- Execution Code ------------------------------- at the End (D) or Indirect 1. action Date, if (Instr. 8) (A) of Issuer's Indirect Beneficial Title of Security Date any ------------ or Fiscal Year (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Amount (D) Price (Instr. 3 & 4) (Instr.4) (Instr.4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 7/1/02 3 (5) 196,821 D $.01 per share ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 7/1/02 3 (5) 138 D- By $.01 per share Group Holdings, Inc. (2) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 7/1/02 3 (5) 51,961 D- By $.01 per share Robert M. Bass (3) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the form is filed by more than one reporting person, see instruction 4(b)(v). 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 CONTROL NUMBER. (OVER) SEC 2270 (9-02) Page 1 of 4 FORM 5 (continued) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ================================================================================
10. 9. Owner- Number ship 2. of of Conver- 5. 7. Deriv- Deriv- 11. sion Number of Title and Amount ative ative Nature or Derivative 6. of Underlying 8. Secur- Secur- of Exer- 3A. 4. Securities Date Securities Price ities ity: In- cise Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Bene- Direct direct Price 3. Execut- action or Disposed Expiration Date ---------------- Deriv- ficially (D) or Bene- 1. of Trans- ion Code of(D) (Month/Day/Year) Amount ative Owned In- ficial Title of Deriv- action Date if (Instr. (Instr. 3, ---------------- or Secur- at End direct Owner- Derivative ative Date any 8) 4 and 5) Date Expira- Number ity of Year (I) ship Security Secur- (mm/dd/ (mm/dd/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity yy) yy) (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: KEYSTONE, INC. /s/ Kevin G. Levy February 14, 2003 --------------------------------------------- ----------------------- **Signature of Reporting Person Date Name: Kevin G. Levy Title: Vice President ** 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. Page 2 of 4 CONTINUATION SHEET TO FORM 5 -------------------------------------------------------------------------------- Name and Address Reporting Person: Keystone, Inc. 201 Main Street, Suite 3100 Fort Worth, Texas 76102 Issuer Name and Ticker or Trading Symbol: Packaging Dynamics Statement for Month/Day/Year: Corporation (PDKY) December 31, 2002 -------------------------------------------------------------------------------- Other Reporting Persons: Signatures of Reporting Persons: Group Holdings, Inc. (2) GROUP HOLDINGS, INC. 201 Main Street, Suite 3100 Fort Worth, Texas 76102 By: /s/ Kevin G. Levy ---------------------------- Kevin G. Levy, Vice President Robert M. Bass (3) ROBERT M. BASS 201 Main Street, Suite 3100 Fort Worth, Texas 76102 By: /s/ Kevin G. Levy ---------------------------- Kevin G. Levy, Attorney-in-Fact(4) Explanation of Responses: (1) The Reporting Persons may be deemed to be a member of a Section 13(d) "group" that owns more than 10% of the Issuer's outstanding Common Stock. However, the Reporting Persons disclaim such group membership and this report shall not be deemed an admission that any Reporting Person is a member of a Section 13(d) group that owns more than 10% of the Issuer's outstanding Common Stock for purposes of Section 16 or for any other purpose. (2) Keystone, Inc. ("Keystone") is the sole stockholder of Group Holdings, Inc. ("Group Holdings"), which is the direct beneficial owner of 138 shares of the Issuer's Common Stock reported herein. Pursuant to Rule 16a-1(a)(2)(ii)(B) under the Act, Keystone may be deemed to be the beneficial owner of the securities beneficially owned by Group Holdings. Pursuant to Rule 16a-1(a)(4) under the Act, this filing shall not be deemed an admission that Keystone is, for purposes of Section 16 of the Act or otherwise, the beneficial owner of any securities owned by Group Holdings in excess of such amount. (3) Robert M. Bass ("RMB") is the beneficial owner of 51,961 shares of the Issuer's Common Stock reported herein. RMB is the President and a controlling person of Keystone, which is the direct beneficial owner of 196,959 shares of the Issuer's Common Stock reported herein. As such, RMB may be deemed to beneficially own such Page 3 of 4 securities pursuant to Rule 16a-1(a)(2)(i). Pursuant to Rule 16a-(a)(4) under the Act, this filing shall not be deemed an admission that RMB is, for purposes of Section 16 of the Act or otherwise, the beneficial owner of any such securities in which he does not have a pecuniary interest. (4) A Power of Attorney authorizing Kevin G. Levy, et al., to act on behalf of Robert M. Bass previously has been filed with the Securities and Exchange Commission. (5) The Reporting Persons acquired beneficial ownership of the securities reported herein on July 1, 2002. Page 4 of 4