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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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 Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Options | $ 0.28 | 11/14/2005 | D(1) | 20,000 | (3) | 10/01/2012(4) | Common Stock | 20,000 | (5) | 0 | D | ||||
Stock Options | $ 0.3 | 11/14/2005 | D(1) | 10,000 | (3) | 10/01/2013(4) | Common Stock | 10,000 | (6) | 0 | D | ||||
Stock Options | $ 0.78 | 11/14/2005 | D(1) | 10,000 | (3) | 01/01/2014(4) | Common Stock | 10,000 | (7) | 0 | D | ||||
Stock Options | $ 0.62 | 11/14/2005 | D(1) | 10,000 | (3) | 01/01/2015(4) | Common Stock | 10,000 | (8) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BERLIN EMILY 14051 N.W. 14TH STREET SUITE 200 FORT LAUDERDALE, FL 33323 |
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Marc Weinstein on behalf of Emily Berlin by power of attorney. | 11/16/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | As of November 14, 2005, Mayor's Jewelers, Inc. ("Mayor's") merged with a wholly-owned subsidiary of Henry Birks & Sons Inc. ("Birks"), and the Reporting Person received shares in Birks in exchange for her Mayor's shares. |
(2) | Disposed of pursuant to merger agreement between Mayor's and Birks in exchange for 4,347 shares of Birks Class A Voting Stock having a market value of $7.00 per share. |
(3) | All options are currently exercisable. |
(4) | Options expire two (2) years after Reporting Person ceases to be a director. |
(5) | This option was assumed by Birks in the merger and replaced with an option to purchase 1739 shares of Birks Class A Voting Stock for $3.22 per share. |
(6) | This option was assumed by Birks in the merger and replaced with an option to purchase 869 shares of Birks Class A Voting Stock for $3.45 per share. |
(7) | This option was assumed by Birks in the merger and replaced with an option to purchase 869 shares of Birks Class A Voting Stock for $8.97 per share. |
(8) | This option was assumed by Birks in the merger and replaced with an option to purchase 869 shares of Birks Class A Voting Stock for $7.13 per share. |