-----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, Q3Bklvv13BrzFMU2xXeiWxMQ08GCKBU4TfpV+EHrdininje7Olb2TK6YbXaMk0Vv YUQRMnVLJU4ebT46zMSKzQ== 0001179110-05-012210.txt : 20050613 0001179110-05-012210.hdr.sgml : 20050611 20050613175619 ACCESSION NUMBER: 0001179110-05-012210 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050609 FILED AS OF DATE: 20050613 DATE AS OF CHANGE: 20050613 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MOVIE GALLERY INC CENTRAL INDEX KEY: 0000925178 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-VIDEO TAPE RENTAL [7841] IRS NUMBER: 631120122 STATE OF INCORPORATION: DE FISCAL YEAR END: 0103 BUSINESS ADDRESS: STREET 1: 900 WEST MAIN STREET CITY: DOTHAN STATE: AL ZIP: 36301 BUSINESS PHONE: 3346772108 MAIL ADDRESS: STREET 1: 900 WEST MAIN STREET CITY: DOTHAN STATE: AL ZIP: 36301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Cousins Keith A CENTRAL INDEX KEY: 0001295392 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24548 FILM NUMBER: 05893221 BUSINESS ADDRESS: BUSINESS PHONE: (334) 677-2108 MAIL ADDRESS: STREET 1: 900 WEST MAIN STREET CITY: DOTHAN STATE: AL ZIP: 36301 4 1 edgar.xml FORM 4 - X0202 4 2005-06-09 0 0000925178 MOVIE GALLERY INC MOVI 0001295392 Cousins Keith A 9112 STURBRIDGE ROAD MONTGOMERY AL 36116 0 1 0 0 Exec.V.P. - Development Common Stock 2005-06-09 4 A 0 6250 .001 A 16250 D These shares represent restricted stock awarded to the Reporting Person under the Movie Gallery, Inc. 2003 Stock Plan at a purchase price equal to the par value of the Issuer's Common Stock, 50% of which are subject to restrictions on transfer and forfeiture upon failure to attain specific performance objectives by the end of the Issuer's 2005 fiscal year, and 50% of which are subject to restrictions on transfer and forfeiture upon failure to attain specific performance objectives by the end of the Issuer's 2006 fiscal year. S. Page Todd, as Attorney-in-fact 2005-06-13 -----END PRIVACY-ENHANCED MESSAGE-----