4 1 form-4_pipkin.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(h) 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* PIPKIN HELEN -------------------------------------------------------------------------------- (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/Day/Year 11/27/02 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [_] Director [_] 10% Owner [X] Officer (give title below) [_] Other (specify below) SENIOR VICE PRESIDENT OF WHOLESALE OPERATIONS ________________________________________________________________________________ 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. Amount of Owner- Securities Acquired (A) or Securities ship 3. Disposed of (D) Beneficially Form: 7. 2A. Transaction (Instr. 3, 4 and 5) Owned Follow- Direct Nature of 2. Deemed Code ----------------------------- ing Reported (D) or Indirect 1. Transaction Execution (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Date Date, if any ------------ or (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V Amount (D) Price and 4) (Instr.4) (Instr. 4) ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK 11/27/02 M 8,000 A $17.63 ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK 11/27/02 M 5,000 A $20.51 ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK 11/27/02 S 13,000 D $28.02 0 D ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ===================================================================================================================================
(Print or Type Response) 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 3A. Derivative 6. of Underlying 8. ities ities of Exer- Deemed 4. Securities Date Securities Price Bene- Benefi- In- cise 3. Execu- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficial- cially direct Price Trans- tion action or Disposed Expiration Date ---------------- Deriv- ly Owned Owned Bene- 1. of action Date, Code of (D) (Month/Day/Year) Amount ative Follow- at End ficial Title of Deriv- Date if any (Instr. (Instr. 3, ----------------- or Secur- ing Re of Owner- Derivative ative (Month/ (Month/ 8) 4 and 5) Date Expira- Number ity ported Month ship Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. Trans- (Instr. (Instr (Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) action(s) 4) 4) ----------------------------------------------------------------------------------------------------------------------------------- EMPLOYEE $17.63/ 11/27/02 M 8,000 (1) 5/19/09 COMMON 8,000 5,333 D STOCK SHARE STOCK OPTION (RIGHT TO BUY) ----------------------------------------------------------------------------------------------------------------------------------- EMPLOYEE $20.51/ 11/27/02 M 5,000 (2) 5/6/11 COMMON 5,000 11,000 D STOCK SHARE STOCK OPTION (RIGHT TO BUY) ===================================================================================================================================
Explanation of Responses: (1) Options to purchase 40,000 shares of the issuer's common stock (as adjusted for stock dividends) were granted on May 19, 1999; these options vested in three equal annual installments beginning on May 19, 2000; 26,667 of these options previously have been exercised. (2) Options to purchase 16,000 shares of the issuer's common stock (as adjusted for stock dividends) were granted on May 6, 2001; these options vest in three equal annual installments beginning on May 6, 2002. /S/ HELEN PIPKIN DECEMBER 1, 2002 --------------------------------------------- ----------------------- **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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2