SEC Form 4 · accession 0001179110-16-031808
SUPREME INDUSTRIES INC · STS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Herbert M Gardner
Officer — Chairman of Board · Director
Period of report
Nov 16, 2016
Accepted (ET)
Nov 17, 2016 · 8:01 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000350846
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class A Common Stock | Nov 16, 2016 | M | 31,500 | $2.12 | A | 284,893 | D | |
| Class A Common Stock | Nov 16, 2016 | F | 4,604 | $14.53 | D | 280,289 | D | |
| Class A Common StockF1 | holding | — | — | — | 969 | I | By GST U/W/O Mary K. Gardner | |
| Class B Common StockF2,F1 | holding | — | — | — | 66,516 | I | By GST U/W/O Mary K. Gardner | |
| Class B Common StockF2 | holding | — | — | — | 587,862 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Incentive Stock OptionF4,F3 | $2.12 | Nov 16, 2016 | M | 31,500 | D | — | Sep 30, 2017 | Class A Common Stock | 31,500 | 0 | D |
Explanation of responses
- F1Reporting Person disclaims beneficial ownership of shares owned by the Generation Skipping Marital Trust U/W/O Mary K. Gardner, of which the Reporting Person is a Co-Trustee.
- F2Class B Common Stock is freely convertible on a one-for-one basis into an equal number of shares of Class A Common Stock.
- F3All options are currently exercisable.
- F4Not applicable.