SEC Form 5
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
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response: 1.0
  
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.
X
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
Day Stephen L

(Last) (First) (Middle)
525 GREAT RD

(Street)
LITTLETON MA 01460

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
DOVER SADDLERY INC [ DOVR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
CEO, President & Treasurer
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2009
4. 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 Acquired, Disposed of, or Beneficially Owned
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 524,587(1) D
Common Stock 12/16/2009 12/16/2009 P4 76,937 A $2.14 601,524(2) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 $10 12/30/2005 11/16/2015 Common Stock 3,500 80,437(3) D
Incentive Stock Option $8.25 (4) 10/25/2011 Common Stock 15,725 96,162(5) D
Non-Qualified Stock Option (right to buy) $7.5 (4) 10/25/2016 Common Stock 3,500 3,500(6) D
Incentive Stock Option $4.95 (7) 11/13/2012 Common Stock 15,725 111,887(8) D
Non-Qualified Stock Option (right to buy) $4.5 (7) 11/13/2017 Common Stock 3,500 7,000(9) D
Incentive Stock Option $1.36 (10) 11/20/2013 Common Stock 13,220 125,107(11) D
Non-Qualified Stock Option (right to buy) $1.24 (10) 11/20/2018 Common Stock 2,940 9,940(12) D
Incentive Stock Option $2.14 12/16/2009 12/16/2009 C 76,937 (13) 12/30/2009 Common Stock 76,937 $2.14 48,170(14) D
Explanation of Responses:
1. As of 12/31/2008.
2. As of 12/31/2009. Reflects total shares of common stock held by this reporting person, after exercising Incentive Stock Option to purchase 76,937 shares of common stock, as previously reported in Table II.
3. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2005.
4. Granted on 10/26/2006 and vest on anniversary date of grant at rate 20 % per year for five years.
5. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2006. Together with Non-Qualified Stock Options the total stock options held by this reporting person equals 99,662 as of 12/31/2006.
6. Reflects total outstanding Non Qualified Stock Options held by this reporting person as of 12/31/2006. Together with Incentive Stock Options the total stock options held by this reporting person equals 99,662 as of 12/31/2006.
7. Granted on 11/14/2007 and vest on anniversary date of grant at rate 20 % per year for five years.
8. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2007.Together with Non-Qualified Stock Options the total stock options held by this reporting person equals 118,887 as of 12/31/2007.
9. Reflects total outstanding Non Qualified Stock Options held by this reporting person as of 12/31/2007. Together with Incentive Stock Options the total stock options held by this reporting person equals 118,887 as of 12/31/2007.
10. Granted on 11/21/2008 and vest on anniversary date of grant at rate 20 % per year for five years.
11. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2008.Together with Non-Qualified Stock Options the total stock options held by this reporting person equals 135,047 as of 12/31/2008.
12. Reflects total outstanding Non Qualified Stock Options held by this reporting person as of 12/31/2008. Together with Incentive Stock Options the total stock options held by this reporting person equals 135,047 as of 12/31/2008.
13. Immediately
14. Reflects total outstanding Incentive Stock Options held by this reporting person as of 12/31/2009.Together with Non-Qualified Stock Options the total stock options held by this reporting person equals 58,110 as of 12/31/2009.
Remarks:
All transactions reported on this Form 5 have been previously reported on Forms 3 and 4 in a timely matter.
/s/ Stephen L. Day 02/16/2010
** 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.