-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, LnwcnJUDC9YxJ+QOoNxTCylr4VrU2uHPvYnO+F6Po6VTnYwL89H8KNx+HvRrjnkk RbSzUzAuzPZD/Sd/bumkiA== 0000950144-97-001302.txt : 19970222 0000950144-97-001302.hdr.sgml : 19970222 ACCESSION NUMBER: 0000950144-97-001302 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970213 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTERFACE INC CENTRAL INDEX KEY: 0000715787 STANDARD INDUSTRIAL CLASSIFICATION: CARPETS AND RUGS [2273] IRS NUMBER: 581451243 STATE OF INCORPORATION: GA FISCAL YEAR END: 0103 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-35163 FILM NUMBER: 97531189 BUSINESS ADDRESS: STREET 1: 2859 PACES FERRY RD STREET 2: STE 2000 CITY: ATLANTA STATE: GA ZIP: 30339 BUSINESS PHONE: 4043196471 FORMER COMPANY: FORMER CONFORMED NAME: INTERFACE FLOORING SYSTEMS INC DATE OF NAME CHANGE: 19870817 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: ANDERSON RAY C CENTRAL INDEX KEY: 0000937733 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] STATE OF INCORPORATION: GA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 2859 PACES FERRY ROAD STREET 2: SUITE 2000 CITY: ATLANTA STATE: GA ZIP: 30339 MAIL ADDRESS: STREET 1: C/O KILPATRICK & CODY STREET 2: 1100 PEACHTREE ST CITY: ATLANTA STATE: GA ZIP: 30309-4530 SC 13G/A 1 INTERFACE, INC. 1 SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. 5)* INTERFACE, INC. ----------------------------------------- (Name of Issuer) CLASS A COMMON STOCK ($0.10 PAR VALUE) ----------------------------------------- (Title of Class of Securities) 458655106 -------------- (CUSIP Number) - ---------------------------------- *The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). 2 CUSIP No. 458655106 - ------------------- 1. NAME OF REPORTING PERSON S.S. or I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Ray C. Anderson 2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP N/A 3. SEC USE ONLY 4. CITIZENSHIP OR PLACE OF ORGANIZATION United States of America NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH 5. SOLE VOTING POWER 2,209,050 6. SHARED VOTING POWER None 7. SOLE DISPOSITIVE POWER 1,608,713 8. SHARED DISPOSITIVE POWER None 9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 2,221,050 10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* N/A 11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 9.03% 12. TYPE OF REPORTING PERSON* IN - ------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! 3 SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13-G Information Statement Pursuant to Rules 13d-1 and 13d-2 (Amendment No. 5) Item 1 (a) NAME OF ISSUER: Interface, Inc. Item 1 (b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES: 2859 Paces Ferry Road, Suite 2000 Atlanta, Georgia 30339 Item 2 (a) NAME OF PERSON FILING: Ray C. Anderson Item 2 (b) ADDRESS OF PRINCIPAL BUSINESS OFFICE: 2859 Paces Ferry Road, Suite 2000 Atlanta, Georgia 30339 Item 2 (c) CITIZENSHIP: United States of America Item 2 (d) TITLE OF CLASS OF SECURITIES: Class A Common Stock ($0.10 Par Value) Item 2 (e) CUSIP NUMBER: 458655106 Item 3 STATEMENTS FILED PURSUANT TO RULES 13d-1(b) OR 13d-2(b): Not Applicable Item 4 (a) AMOUNT BENEFICIALLY OWNED: I am the beneficial owner, as of December 31, 1996, of 2,221,050 shares of Class A Common Stock for the purpose of Section 13(g) of the Securities Exchange Act of 1934 by virtue of Rule 13d-3. This ownership consists of (i) 1,600,713 shares of Class B Common Stock, which are convertible on a one-for- one basis into shares of Class A Common Stock, owned directly by me, (ii) 608,337 additional shares of Class B Common Stock which I have the power to direct the voting of pursuant to a Voting Agreement, (iii) 4,000 shares of Class A Common Stock held of record by my wife (as to which I disclaim beneficial ownership) and (iv) 8,000 shares of Class A or B Common Stock issuable upon the exercise of stock options which are currently exercisable or exercisable within 60 days. 4 Item 4 (b) PERCENT OF CLASS: If all of the Class B Common Stock and options that I beneficially own were converted into Class A Common Stock, I would beneficially own 9.03% of the outstanding Class A Common Stock, computed in accordance with Rule 13d-3. Item 4 (c) NUMBER OF SHARES AS TO WHICH REPORTING PERSON HAS: (i) Sole power to vote or to direct vote: 2,209,050 (ii) Shared power to vote or to direct the vote: None (iii) Sole power to dispose or to direct the disposition of: 1,608,713 (iv) Shared power to dispose or to direct the disposition of: None Item 5 OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS: Not Applicable Item 6 OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON: Not Applicable Item 7 IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRES THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY: Not Applicable Item 8 IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP: Not Applicable Item 9 NOTICE OF DISSOLUTION OF GROUP: Not Applicable Item 10 CERTIFICATION: Not Applicable 5 SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. /s/ Ray C. Anderson ------------------------- Ray C. Anderson Dated: February 10, 1997 -----END PRIVACY-ENHANCED MESSAGE-----