-----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, SWX69/qE+biFzHxfRVKSKbjT1pO/2PZHbd6oBv1afFtAycJ+S8MUIBxWsxk+j0cQ KaYa5UPnJvMhSg6xOxBAnw== 0001179110-05-009068.txt : 20050506 0001179110-05-009068.hdr.sgml : 20050506 20050505220011 ACCESSION NUMBER: 0001179110-05-009068 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050505 FILED AS OF DATE: 20050505 DATE AS OF CHANGE: 20050505 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Zumiez Inc CENTRAL INDEX KEY: 0001318008 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-APPAREL & ACCESSORY STORES [5600] IRS NUMBER: 911040022 BUSINESS ADDRESS: STREET 1: 6300 MERRILL CREEK PARKWAY STREET 2: SUITE B CITY: EVERETT STATE: WA ZIP: 98203 BUSINESS PHONE: 425-551-1564 MAIL ADDRESS: STREET 1: 6300 MERRILL CREEK PARKWAY STREET 2: SUITE B CITY: EVERETT STATE: WA ZIP: 98203 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Brentwood Private Equity III, LLC CENTRAL INDEX KEY: 0001324256 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51300 FILM NUMBER: 05805314 BUSINESS ADDRESS: STREET 1: 11150 SANTA MONICA BLVD. STREET 2: SUITE 1200 CITY: LOS ANGELES STATE: CA ZIP: 90025 BUSINESS PHONE: 310-477-6611 MAIL ADDRESS: STREET 1: 11150 SANTA MONICA BLVD. STREET 2: SUITE 1200 CITY: LOS ANGELES STATE: CA ZIP: 90025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Brentwood Associates Private Equity III-A, L.P. CENTRAL INDEX KEY: 0001324288 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51300 FILM NUMBER: 05805315 BUSINESS ADDRESS: STREET 1: 11150 SANTA MONICA BLVD. STREET 2: SUITE 1200 CITY: LOS ANGELES STATE: CA ZIP: 90025 BUSINESS PHONE: 310-477-6611 MAIL ADDRESS: STREET 1: 11150 SANTA MONICA BLVD. STREET 2: SUITE 1200 CITY: LOS ANGELES STATE: CA ZIP: 90025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRENTWOOD ASSOCIATES PRIVATE EQUITY III LP CENTRAL INDEX KEY: 0001088576 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51300 FILM NUMBER: 05805316 BUSINESS ADDRESS: STREET 1: 11150 SANTA MONICA BLVD STREET 2: STE 1200 CITY: LOS ANGELES STATE: CA ZIP: 90025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BAPE III EXECUTIVE FUND L P CENTRAL INDEX KEY: 0001108801 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51300 FILM NUMBER: 05805317 BUSINESS ADDRESS: STREET 1: 11150 SANTA MONICA BOULEVARD STREET 2: SUITE 1200 CITY: LOS ANGELES STATE: CA ZIP: 90025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Brentwood-Zumiez Investors, LLC CENTRAL INDEX KEY: 0001324255 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51300 FILM NUMBER: 05805318 BUSINESS ADDRESS: STREET 1: 11150 SANTA MONICA BLVD. STREET 2: SUITE 1200 CITY: LOS ANGELES STATE: CA ZIP: 90025 BUSINESS PHONE: 310-477-6611 MAIL ADDRESS: STREET 1: 11150 SANTA MONICA BLVD. STREET 2: SUITE 1200 CITY: LOS ANGELES STATE: CA ZIP: 90025 3 1 edgar.xml FORM 3 - X0202 3 2005-05-05 0 0001318008 Zumiez Inc ZUMZ 0001324255 Brentwood-Zumiez Investors, LLC 11150 SANTA MONICA BLVD. SUITE 1200 LOS ANGELES CA 90025 0 0 1 0 0001108801 BAPE III EXECUTIVE FUND L P 11150 SANTA MONICA BLVD. SUITE 1200 LOS ANGELES CA 90025 0 0 0 1 Affiliate of 10% owner 0001088576 BRENTWOOD ASSOCIATES PRIVATE EQUITY III LP 11150 SANTA MONICA BLVD. SUITE 1200 LOS ANGELES CA 90025 0 0 0 1 Affiliate of 10% owner 0001324288 Brentwood Associates Private Equity III-A, L.P. 11150 SANTA MONICA BLVD. SUITE 1200 LOS ANGELES CA 90025 0 0 0 1 Affiliate of 10% owner 0001324256 Brentwood Private Equity III, LLC 11150 SANTA MONICA BLVD. SUITE 1200 LOS ANGELES CA 90025 0 0 1 0 Common stock 4296530 D Common stock 4296530 I See footnote Common stock 4296530 I See footnote Common stock 4296530 I See footnote Common stock 4296530 I See footnote Reflects securities held by Brentwood-Zumiez Investors, LLC. Brentwood Private Equity III, LLC is the general partner of Brentwood Associates Private Equity III, L.P., Brentwood Associates Private Equity III-A, L.P. and BAPE III Executive Fund, L.P., which collectively hold all of the membership interests of Brentwood-Zumiez Investors, LLC. Reflects securities held by Brentwood-Zumiez Investors, LLC, of which BAPE III Executive Fund, L.P. is a member. BAPE III Executive Fund, L.P. disclaims beneficial ownership of these securities, except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that such reporting person is the beneficial owner of the securities for Section 16 purposes or for any other purpose. Reflects securities held by Brentwood-Zumiez Investors, LLC, of which Brentwood Associates Private Equity III, L.P. is a member. Brentwood Associates Private Equity III, L.P. disclaims benefical ownership of these securities, except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that such reporting person is the beneficial owner of the securities for Section 16 purposes or for any other purpose. Reflects securities held by Brentwood-Zumiez Investors, LLC, of which Brentwood Associates Private Equity III-A, L.P. is a member. Brentwood Associates Private Equity III-A, L.P. disclaims benefical ownership of these securities, except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that such reporting person is the beneficial owner of the securities for Section 16 purposes or for any other purpose. William M. Barnum, Jr., authorized representative 2005-05-05 William M. Barnum, Jr., authorized representative 2005-05-05 William M. Barnum, Jr., authorized representative 2005-05-05 William M. Barnum, Jr., authorized representative 2005-05-05 William M. Barnum, Jr., authorized representative 2005-05-05 -----END PRIVACY-ENHANCED MESSAGE-----