0001209191-12-038550.txt : 20120718
0001209191-12-038550.hdr.sgml : 20120718
20120718172909
ACCESSION NUMBER: 0001209191-12-038550
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20120718
FILED AS OF DATE: 20120718
DATE AS OF CHANGE: 20120718
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Collins Steven J
CENTRAL INDEX KEY: 0001310177
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35600
FILM NUMBER: 12968657
MAIL ADDRESS:
STREET 1: C/O ADVENT INTERNATIONAL CORPORATION
STREET 2: 75 STATE STREET
CITY: BOSTON
STATE: MA
ZIP: 02109
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: FIVE BELOW, INC
CENTRAL INDEX KEY: 0001177609
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-VARIETY STORES [5331]
IRS NUMBER: 000000000
STATE OF INCORPORATION: PA
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1818 MARKET STREET
STREET 2: SUITE 1900
CITY: PHILADELPHIA
STATE: PA
ZIP: 19103
BUSINESS PHONE: 215 546 7909
MAIL ADDRESS:
STREET 1: 1818 MARKET STREET
STREET 2: SUITE 1900
CITY: PHILADELPHIA
STATE: PA
ZIP: 19103
FORMER COMPANY:
FORMER CONFORMED NAME: FIVE BELOW INC
DATE OF NAME CHANGE: 20030305
FORMER COMPANY:
FORMER CONFORMED NAME: CHEAP HOLDINGS INC
DATE OF NAME CHANGE: 20020717
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2012-07-18
0
0001177609
FIVE BELOW, INC
FIVE
0001310177
Collins Steven J
C/O ADVENT INTERNATIONAL CORPORATION
75 STATE STREET, 29TH FLOOR
BOSTON
MA
02109
1
0
0
0
Series A 8% Convertible Preferred Stock
Common Stock
9364
I
See Footnote
The Series A 8% Convertible Preferred Stock is convertible into Five Below, Inc. common stock on a 1-for-0.346 basis and has no expiration date.
These shares are indirectly beneficially owned as a limited partner of Advent Partners GPE VI 2008 Limited Partnership, which in turn is a shareholder of Advent - Five Below Acquisition Limited Partnership, which is the direct owner of these securities.
Jarlyth H. Gibson, Compliance Officer
2012-07-18
EX-24.3_432674
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
Know all by these presents that the undersigned hereby constitutes and appoints
Jarlyth H. Gibson and Anna J. Guerin, each of them acting singly, his true
attorney-in-fact to:
(1) execute for and on behalf of the undersigned, Rule 144 filings, Forms 3, 4,
and 5; related to Five Below, Inc. in accordance with Section 16(a) of the
Securities Exchange Act of 1934 and the rules thereunder;
(2) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete the execution of any such Rule 144
filings, Forms 3, 4, and 5 and the timely filing of such forms with the United
States Securities and Exchange Commission and any other authority; and
(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that any document filed pursuant to this Power of Attorney shall be
in such form and shall contain such terms and conditions as such
attorney-in-fact may approve in his/her discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform all and every act and thing whatsoever requisite,
necessary and proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or his/her
substitute or substitutes, shall lawfully do or cause to be done by virtue of
this Power of Attorney and the rights and powers granted. The undersigned
acknowledges that the foregoing attorneys-in-fact, in serving in such capacity
at the request of the undersigned, are not assuming any of the undersigned's
responsibilities to comply with any section of either the Securities Act of 1933
or the Securities Exchange Act of 1934.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this
13th day of July, 2012.
/s/ Steven J. Collins
Steven J. Collins