-----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, OBJO1lD/eQtFIsv7MjXcWnaCohmT4IwFRS/L73RvwYv7xX0ILbkCQjn38ZPFpBwV ElCYY6jGnFiFQHQh0snB0Q== 0000935703-99-000006.txt : 19990211 0000935703-99-000006.hdr.sgml : 19990211 ACCESSION NUMBER: 0000935703-99-000006 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981231 FILED AS OF DATE: 19990210 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: DOLLAR TREE STORES INC CENTRAL INDEX KEY: 0000935703 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-VARIETY STORES [5331] IRS NUMBER: 541387365 STATE OF INCORPORATION: VA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-25464 FILM NUMBER: 99527914 BUSINESS ADDRESS: STREET 1: 500 VOLVO PARKWAY STREET 2: NORFOLK COMMERCE PARK CITY: CHESAPEAKE STATE: VA ZIP: 23320 BUSINESS PHONE: 7573215000 MAIL ADDRESS: STREET 1: P.O. BOX 2500 CITY: NORFOLK STATE: VA ZIP: 23501-2500 COMPANY DATA: COMPANY CONFORMED NAME: GURNEE ROBERT G CENTRAL INDEX KEY: 0001052598 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: P O BOX 2500 CITY: NORFOLK STATE: VA ZIP: 23501-2500 BUSINESS PHONE: 7573215000 5 1
- ---------------- U.S. SECURITIES AND EXCHANGE COMMISSION ---------------------------- |F O R M 5| Washington, D.C. 20549 | OMB APPROVAL | - ---------------- |--------------------------| Check this box if ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |OMB Number 3235-0362| [ ] no longer Subject |Expires: September 30,1998| to Section 16. |Estimated ave. burden | |hours per response.....1.0| [ ] Form 3 Holdings Rep. 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 [ ] Form 4 Trans. Rep. Section 30(f) of the Investment Company Act 1940 - ------------------------------------------------------------------------------------------------------------------------------------ |1.Name and Address of Reporting Person* |2.Issuer Name and Ticker or Trading Symbol |6.Relationship of Reporting Person to | | | | Issuer (Check all Applicable) | |Gurnee Robert G. |DOLLAR TREE STORES, INC. | | | | (DLTR) | | | | | Director 10% Owner | |----------------------------------------|------------------------------------------------|--- --- | | (Last) (First) (MI)|3.IRS or Soc. Sec. No. |4.Statement for Month/ | X Officer Other | | | of Reporting Person | Year |---(give title below) ---(Specify below)| | 500 VOLVO PARKWAY | (Voluntary) | | | | | | 12/31/1998 | | | | | | Vice President, Real Estate | |----------------------------------------| |------------------------|----------------------------------------| | (Street) | |5.If Amendment, Date of |7. Individual or Joint/Group Filing | | | ###-##-#### | Original (Month/Year) | (Check Applicable Line) | | | | | | |CHESAPEAKE VA 23320 | | | X Form filed by One Reporting Person | | | | |--- | | | | | Form filed by More than One | | | | |--- Reporting Person | |----------------------------------------------------------------------------------------------------------------------------------| | (City) (State) (Zip) | | TABLE I - Non-Derivative Securities Acquired, Disposed of or Beneficially Owned | |----------------------------------------------------------------------------------------------------------------------------------| |1.Title of Security |2.Transac- |3.Trans. |4.Security Acquired (A) or |5.Amount of |6. |7.Nature of Indirect| | (Instr. 3) | tion Date | Code | Disposed of (D) | Securities |Own.| Beneficial | | |(Mon/Day/Yr)|(Instr.8)| (Instr. 3, 4 & 5) | Beneficially |Form| Ownership | | | | | | Owned at End of|(D) | (Instr. 4) | | | | |-------------------------------| Issuer's |or | | | | | | |(A) | | Fiscal Year |(I) | | | | | | Amount |(D) | Price | (Instr. 3 & 4) | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | |Common Stock | 01/02/1998 | B | 127 | A | $23.4500| | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| |Common Stock | 04/01/1998 | B | 237 | A | $23.4400| | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| |Common Stock | 07/01/1998 | B | 101 | A | $29.6800| | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| |Common Stock | 10/01/1998 | B | 113 | A | $26.6200| 3849 | D | | | | | | | | | (01)| | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class securities owned directly or indirectly. SEC 2270 (7-96) *If the form is filed by more than one reporting person, see Instruction 4(b)(v). PAGE: 1 OF 3
FORM 5 (continued) TABLE II - Derivative Securities Acquired, Disposed of, Beneficially Owned (e.g., puts, calls, warrants, options, convertible security) - ------------------------------------------------------------------------------------------------------------------------------------ |1.Title of|2.Conver-|3. |4.Tran- |5.Number of |6.Date |7.Title and Amount |8.Price of|9.Number |10. |11.Nature | |Derivative|sion or |Trans| saction| Derivative |Exercisable| of Underlying |Derivative| of |Own.| of | |Security |Exercise |Date | Code | Securities |and | Securities |Security |Derivative|Form|Indirect | |(Instr. 3)|Price of |(Mon/|(Instr.8)| Acquired (A) or |Expiration | (Instr. 3 & 4) |(Instr. 5)|Securities|of |Beneficial| | |Deriva- | Day/| | Disposed of (D) |Date | | |Benefi- |Deri|Ownership | | |tive |Year)| | (Instr. 3, 4 & 5) |(Month/Day/| | |cially |Sec.|(Instr. 4)| | |Security | | | | Year) | | |Owned at |Dir.| | | | | | | |-----------|---------------------| |End of |(D) | | | | | | | | | | |Amount or | |Year |or | | | | | | |---------------------|Date |Exp. | Title |Number of | |(Instr. 4)|Ind.| | | | | | | (A) | (D) |Exbl.|Date | |Shares | | |(I) | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | |Stock Opti| $1.2889| | | | | | |Common Sto| 4237| | 4237| D | | |on | | | | | | | |ck | | | | | | | | | | | | | | | | | | | | | | | | | | | | | (02)| | | | (01)| | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| |Stock Opti| $4.4445| | | | | | |Common Sto| 7560| | 7560| D | | |on | | | | | | | |ck | | | | | | | | | | | | | | | | | | | | | | | | | | | | (03)| (04)| | | | (01)| | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| |Stock Opti| $7.8889| | | | | | |Common Sto| 8910| | 8910| D | | |on | | | | | | | |ck | | | | | | | | | | | | | | | | | | | | | | | | | | | | (05)| (06)| | | | (01)| | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| |Stock Opti| $14.7222| | | | | | |Common Sto| 6750| | 6750| D | | |on | | | | | | | |ck | | | | | | | | | | | | | | | | | | | | | | | | | | | | (07)| (08)| | | | (01)| | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| |Stock Opti| $14.8889| | | | | | |Common Sto| 13500| | 13500| D | | |on | | | | | | | |ck | | | | | | | | | | | | | | | | | | | | | | | | | | | | (09)| (10)| | | | (01)| | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| |Stock Opti| $34.5000| | | | | | |Common Sto| 22500| | 22500| D | | |on | | | | | | | |ck | | | | | | | | | | | | | | | | | | | | | | | | | | | | (11)| (12)| | | | (01)| | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (01) Balance includes non-reportable purchases under the Dollar Tree Stores, Inc. Employee Stock Purchase Plan. (02) Options lapse upon termination of employment with certain grace periods allowed upon death, disability, or retirement. (03) Options vest over 3 years. Optionee may purchase up to 34% of underlying shares after 3/5/96, up to 68% of underlying s hares after 3/5/97, and up to 100% of underlying shares after 3/5/98. (04) Option lapses upon termination of employment (with certain grace periods) or 3/5/2005, whichever is less. (05) Options vest over 3 years. Optionee may purchase up to 34% of underlying shares after 11/28/96, up to 68% of underlying shares after 11/28/97, and up to 100% of underlying shares after 11/28/98. (06) Option lapses upon termination of employment (with certain grace periods) or 11/28/2005, whichever is less. (07) Options vest over 3 years. Optionee may purchase up to 34% of underlying shares after 4/24/97, up to 68% of underlying shares after 4/24/98, and up to 100% of underlying shares after 4/24/99. **Intentional misstatements or omissions of facts constitute Federal /s/Robert G. Gurnee 02/10/1999 Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------------------ ---------- **Signature of Reporting Person Date Note: File three copies of this form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. SEC 2270 (7-96) 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 OMD Number Gurnee, Robert G. DOLLAR TREE STORES, INC. 12/31/1998 PAGE: 2 OF 3
E X P L A N A T I O N O F R E S P O N S E S (cont.) F O R M 5 (08) Option lapses upon termination of employment (with certain grace periods) or 4/24/2006, whichever is less. (09) Options vest over 3 years. Optionee may purchase up to 34% of underlying shares after 3/18/98, up to 68% of underlying shares after 3/18/99, and up to 100% of underlying shares after 3/18/00. (10) Option lapses upon termination of employment (with certain grace periods) or 3/18/07, whichever is less. (11) Options vest over three years. Optionee may purchase up to 34% of underlying shares after 4/20/99, up to 68% of underlyi ng shares after 4/20/00 and up to 100% of underlying shares after 4/20/01. (12) Options lapse upon termination of employment (with certain grace periods) or 4/20/08, whichever is less.
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