0001127602-12-026823.txt : 20120921 0001127602-12-026823.hdr.sgml : 20120921 20120921152630 ACCESSION NUMBER: 0001127602-12-026823 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120920 FILED AS OF DATE: 20120921 DATE AS OF CHANGE: 20120921 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jacobs David A. CENTRAL INDEX KEY: 0001546549 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25464 FILM NUMBER: 121104163 MAIL ADDRESS: STREET 1: 500 VOLVO PARKWAY CITY: CHESAPEAKE STATE: VA ZIP: 23320 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DOLLAR TREE INC CENTRAL INDEX KEY: 0000935703 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-VARIETY STORES [5331] IRS NUMBER: 541387365 STATE OF INCORPORATION: VA FISCAL YEAR END: 0128 BUSINESS ADDRESS: STREET 1: 500 VOLVO PARKWAY STREET 2: N/A CITY: CHESAPEAKE STATE: VA ZIP: 23320 BUSINESS PHONE: (757) 321-5000 MAIL ADDRESS: STREET 1: 500 VOLVO PARKWAY CITY: CHESAPEAKE STATE: VA ZIP: 23320 FORMER COMPANY: FORMER CONFORMED NAME: DOLLAR TREE STORES INC DATE OF NAME CHANGE: 19950117 4 1 form4.xml PRIMARY DOCUMENT X0306 4 2012-09-20 0000935703 DOLLAR TREE INC DLTR 0001546549 Jacobs David A. 500 VOLVO PARKWAY CHESAPEAKE VA 23320 1 Chief Strategy Officer Common Stock 2012-09-20 4 M 0 18750 8.91 A 32776 D Common Stock 2012-09-20 4 M 0 8750 12.7467 A 41526 D Common Stock 2012-09-20 4 S 0 27500 49.2365 D 14026 D Stock Option (right to buy) 8.91 2012-09-20 4 M 0 18750 0 D 2009-03-14 2018-03-14 Common Stock 18750 0 D Stock Option (right to buy) 12.7467 2012-09-20 4 M 0 8750 0 D 2008-03-30 2017-03-30 Common Stock 8750 0 D Represents the weighted average price for shares sold at the range between $49.21 and $49.265. The filer will provide full information regarding the number of shares sold at each price upon request. Vests in three approximately equal annual installments, beginning the first anniversary of the award date, subject to continued employment. Expires at the earlier of one year after ceasing to be a director, with certain grace periods, or ten years after grant. /s/ Shawnta Totten, attorney-in-fact for David A. Jacobs 2012-09-21