Annual Statement of Changes in Beneficial Ownership (5)
July 02 2015 - 12:18PM
Edgar (US Regulatory)
FORM 5
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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Form 3 Holdings Reported
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X
]
Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
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hours per response...
1.0
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Mulligan Gregory F
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2. Issuer Name
and
Ticker or Trading Symbol
DOVER SADDLERY INC [DOVR]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
525 GREAT RD
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2014
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(Street)
LITTLETON, MA 01460
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
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7. Nature of Indirect Beneficial Ownership
(Instr. 4)
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Amount
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(A) or (D)
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Price
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Common Stock
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3/26/2014
(1)
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3/26/2014
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P4
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12840
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A
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$1.94
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12840
(2)
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D
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Non-Qualified Stock Option
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$7.50
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(3)
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10/25/2016
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Common Stock
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3500
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23940
(4)
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D
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Non-Qualified Stock Option
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$4.50
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(5)
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11/13/2017
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Common Stock
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3500
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23940
(6)
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D
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Non-Qualified Stock Option
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$1.24
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(7)
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11/20/2018
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Common Stock
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2940
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23940
(8)
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D
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Non-Qualified Stock Option
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$3.10
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(9)
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11/16/2020
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Common Stock
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3500
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23940
(10)
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D
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Non-Qualified Stock Option
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$3.32
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(11)
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11/27/2021
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Common Stock
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3500
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23940
(12)
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D
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Non-Qualified Stock Option
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$3.59
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(13)
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11/15/2022
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Common Stock
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3500
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23940
(14)
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D
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Non-Qualified Stock Option
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$4.90
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(15)
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11/19/2023
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Common Stock
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3500
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23940
(16)
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D
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Non-Qualified Stock Option
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$1.94
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3/26/2014
(1)
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3/26/2014
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C4
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12840
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(17)
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3/30/2014
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Common Stock
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12840
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$1.94
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23940
(2)
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D
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Explanation of Responses:
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(
1)
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This transaction has been previously reported on a Form 4 in a timely manner.
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(
2)
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As of 12/31/2014.
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(
3)
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Granted on 10/26/2006 and vest on anniversary date of grant at rate 20 % per year for five years.
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(
4)
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As of 12/31/2014, total includes 3,500 Non-Qualified Stock Options as granted in 2006.
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(
5)
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Granted on 11/14/2007 and vest on anniversary date of grant at rate 20 % per year for five years.
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(
6)
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As of 12/31/2014, total includes 3,500 Non-Qualified Stock Options as granted in 2007.
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(
7)
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Granted on 11/21/2008 and vest on anniversary date of grant at rate 20 % per year for five years.
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(
8)
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As of 12/31/2014, total includes 2,940 Non-Qualified Stock Options as granted in 2008.
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(
9)
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Granted on 11/17/2010 and vest on anniversary date of grant at rate 20 % per year for five years.
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(
10)
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As of 12/31/2014, total includes 3,500 Non-Qualified Stock Options as granted in 2010.
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(
11)
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Granted on 11/28/2011 and vest on anniversary date of grant at rate 20 % per year for five years.
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(
12)
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As of 12/31/2014, total includes 3,500 Non-Qualified Stock Options as granted in 2011.
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(
13)
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Granted on 11/16/2012 and vest on anniversary date of grant at rate 20 % per year for five years.
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(
14)
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As of 12/31/2014, total includes 3,500 Non-Qualified Stock Options as granted in 2012.
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(
15)
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Granted on 11/20/2013 and vest on anniversary date of grant at rate 20 % per year for five years.
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(
16)
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As of 12/31/2014, total includes 3,500 Non-Qualified Stock Options as granted in 2013.
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(
17)
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Immediately
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Remarks:
All transactions reported on this Form 5 have been previously reported on Forms 3 and 4 in timely manner.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Mulligan Gregory F
525 GREAT RD
LITTLETON, MA 01460
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X
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Signatures
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/s/ Gregory F. Mulligan
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2/9/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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