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