SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Boessen Douglas G.

(Last) (First) (Middle)
3231 SOUTHEAST SIXTH AVENUE

(Street)
TOPEKA KS 66607

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/02/2008
3. Issuer Name and Ticker or Trading Symbol
COLLECTIVE BRANDS, INC. [ PSS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Division SVP, CFO & Treasurer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 2,287 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (1) 05/31/2012 Common Stock 7,000 $16.865 D
Employee Stock Option 05/31/2009(2) 04/07/2013 Common Stock 5,000 $22.48 D
Employee Stock Option (3) 04/07/2013 Common Stock 2,100 $22.48 D
Stock Appreciation Right (4) 04/07/2013 Common Stock 1,925 $22.48 D
Stock Appreciation Right (4) 04/07/2013 Common Stock 5,500 $22.48 D
Stock Appreciation Right 05/31/2010(6) 03/29/2014 Common Stock 4,000 $33.115 D
Stock Appreciation Right (5) 03/29/2014 Common Stock 3,925 $33.115 D
Stock Appreciation Right (7) 09/04/2014 Common Stock 5,080 $23.16 D
Stock Appreciation Right 03/27/2011(6) 03/27/2015 Common Stock 5,000 $12.45 D
Stock Appreciation Right 09/08/2011(6) 09/08/2015 Common Stock 2,000 $18.63 D
Explanation of Responses:
1. Grant of an option to buy 10,500 shares of common stock under the Payless ShoeSource, Inc. 1996 Stock Incentive Plan which provides for tax withholding rights in a transaction exempt under Rule 16b3. The option vests in three equal installments over a three-year period beginning on the first anniversary of the date of grant.
2. Grant of an option to buy 5,000 shares of common stock under the Payless ShoeSource, Inc. 1996 Stock Incentive Plan which provides for tax withholding rights in a transaction exempt under Rule 16b3. The option has a three-year cliff vest.
3. Grant of an option to buy 2,100 shares of common stock under the Payless ShoeSource, Inc. 1996 Stock Incentive Plan which provides for tax withholding rights in a transaction exempt under Rule 16b3. The option vests in three equal installments over a three-year period beginning on the first anniversary of the date of grant.
4. The stock appreciation right granted under the Payless ShoeSource, Inc. 1996 Stock Incentive Plan which provides for tax withholding rights under Rule 16b-3. The option vests in three equal installments over a three-year period on May 31 of each year following the date of the grant. The stock appreciation right is required to be settled in stock.
5. The stock appreciation right granted under the Payless ShoeSource, Inc. 2006 Stock Incentive Plan which provides for tax withholding rights under Rule 16b-3. The option vests in three equal installments over a three-year period on May 31 of each year following the date of the grant. The stock appreciation right is required to be settled in stock.
6. The stock appreciation right granted under the Payless ShoeSource, Inc. 2006 Stock Incentive Plan which provides for tax withholding rights in a transaction exempt under Rule 16b-3. The option has a three-year cliff vest. The stock appreciation right is required to be settled in stock.
7. The stock appreciation right granted under the Payless hoeSource, Inc. 2006 Stock Incentive Plan which provides for tax withholding rights in a transaction exempt under Rule 16b-3. The option vests in three equal installments over a three-year period on September 4th of each year following the date of the grant. The stock appreciation right is required to be settled in stock.
Remarks:
Douglas G. Boessen 12/02/2008
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.