FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
Form 3 Holdings Reported. | |||||||||||||||||
Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
DOVER SADDLERY INC [ DOVR ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 12/31/2006 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
Amount | (A) or (D) | Price | |||||||||||||
Common Stock | 11/14/2006 | G | 54,735 | D(1) | (2) | 140,335(3) | D | ||||||||
Common Stock | 11/14/2006 | G | 54,735 | A(1) | (2) | 140,335(3) | D |
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 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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Incentive Stock Option | $1.94 | (4) | 12/30/2014 | Common Stock | 38,665 | 38,665(5) | D | |||||||
Incentive Stock Option | $10 | 12/30/2005 | 11/17/2015 | Common Stock | 15,725 | 54,390(6) | D | |||||||
Incentive Stock Option | $10 | 12/30/2005 | 11/17/2015 | Common Stock | 3,500 | 57,890(6) | D | |||||||
Incentive Stock Option | $7.5 | 10/26/2006 | A | 15,725 | (7) | 10/25/2016 | Common Stock | 15,725 | (8) | 73,615(9) | D | |||
Incentive Stock Option | $7.5 | 10/26/2006 | A | 3,500 | (7) | 10/25/2016 | Common Stock | 3,500 | (8) | 3,500(10) | D |
Explanation of Responses: |
1. The reporting person transferred 54,735 shares of the issuer's Common Stock (the "Shares") to The Jonathan Andrew Richard Grylls Living Trust U/D/T dated September 27, 2006 ("Trust"), of which the reporting person is one of the Trustees. The reporting person continues to have a pecuniary interest in the Trust; as the beneficiary of the Trust, has investment control over the Shares; and as the settlor of the Trust, has the right to revoke the Trust without the consent of another person. |
2. The Shares were transferred to the Trust without consideration for estate planning purposes. |
3. Includes (i) 54,735 shares of the issuer's Common Stock ("Shares") held by the Trust, as the result of the transfer reported hereby, and (ii) 85,600 Shares held by the reporting person. |
4. Immediately. |
5. As of 12/31/2004 |
6. As of 12/3/2005 |
7. Vest on anniversary date of grant at rate 20 % per year for five years. |
8. When exercisable price will be $ 7.50. |
9. Reflects total outstanding Incentive Stock Options held by this person. Together with Non-Qualified Stock Options the total stock options held by this reporting person equals 77,115. |
10. Reflects total only of Non-Qualified Stock Options held by this reporting person. Together with Incentive Stock Options the total stock options held by this reporting person equals 77,115. |
Remarks: |
All transactions reported on this Form 5 have been previously reported on Forms 3 and 4 in a timely manner. |
Jonathan A.R. Grylls | 02/13/2007 | |
** 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 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). | ||
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. |