4 1 form4-howard_gold.txt U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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(f) of the Investment Company Act of 1940 [_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ________________________________________________________________________________ 1. Name and Address of Reporting Person* HOWARD GOLD -------------------------------------------------------------------------------- (Last) (First) (Middle) C/O 99 CENTS ONLY STORES 4000 UNION PACIFIC AVENUE -------------------------------------------------------------------------------- (Street) LOS ANGELES CA 90023 -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol 99 CENTS ONLY STORES (NYSE: "NDN") ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year FEBRUARY 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [X] Officer (give title below) [_] Other (specify below) SENIOR VICE PRESIDENT OF DISTRIBUTION ________________________________________________________________________________ 7. 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 ================================================================================
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 2/27/02 S 144,970 D (1) 5,145,095 I (2) ------------------------------------------------------------------------------------------------------------------------------------ 1,717,853 D ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) 144,970 shares of the Issuer (the "Issuer Shares") were transferred by Au Zone Investments #2, L.P. to Altavera Capital Fund LLC (the "Fund") on February 27, 2002 in exchange for shares of the Fund (the "Fund Shares"). The number of Fund Shares exchanged for the Issuer Shares was based on a per share price of $34.49, which was the per share closing price of the Company's common stock on February 27, 2002. (2) Beneficially owned through Au Zone Investments #2, L.P., a limited partnership in which the reporting person has a limited partnership interest and an interest in the partnership's general partner. * If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Response) (Over) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form of 2. Deriv- Deriv- Conver- 5. 7. ative ative 11. sion Number of Title and Amount Secur- Secur- Nature or Derivative 6. of Underlying 8. ities ities of Exer- 4. Securities Date Securities Price Bene- Benefi- In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially cially direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned Owned Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End at End ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of of Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month Month ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: /S/ HOWARD GOLD 03/01/02 --------------------------------------------- ----------------------- **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 provided is insufficient, see Instruction 6 for procedure. Page 2