-----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, RPxoepSjTXh2qptx8wxH7cGT0tYICisAR+odwo0Xl67s8owuOHuEn4XKZiuH0Kn8 mQMzazr/OgEskKWer9BOHA== 0001209191-04-034626.txt : 20040702 0001209191-04-034626.hdr.sgml : 20040702 20040702170628 ACCESSION NUMBER: 0001209191-04-034626 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040630 FILED AS OF DATE: 20040702 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DOUGLAS LISA M CENTRAL INDEX KEY: 0001235564 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19402 FILM NUMBER: 04900642 BUSINESS ADDRESS: STREET 1: VANS STREET 2: 15700 SHOEMAKER AVE. CITY: SANTA FE SPRINGS STATE: CA ZIP: 90670 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: VANS INC CENTRAL INDEX KEY: 0000877273 STANDARD INDUSTRIAL CLASSIFICATION: RUBBER & PLASTICS FOOTWEAR [3021] IRS NUMBER: 330272893 STATE OF INCORPORATION: DE FISCAL YEAR END: 0531 BUSINESS ADDRESS: STREET 1: 15700 SHOEMAKER AVENUE CITY: SANTA FE SPRINGS STATE: CA ZIP: 90670-5515 BUSINESS PHONE: 5625658267 MAIL ADDRESS: STREET 1: 15700 SHOEMAKER AVENUE CITY: SANTA FE SPRINGS STATE: CA ZIP: 90670-5515 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2004-06-30 1 0000877273 VANS INC VANS 0001235564 DOUGLAS LISA M 15700 SHOEMAKER AVE. SANTA FE SPRINGS CA 90670 1 0 0 0 Stock Option (Right to Buy) 7.75 2004-06-30 4 D 0 5000 D 1999-10-19 2008-10-19 Common Stock 5000 0 D Stock Option (Right to Buy) 11.06 2004-06-30 4 D 0 5000 D 2000-10-25 2009-10-25 Common Stock 5000 0 D Stock Option (Right to Buy) 13.81 2004-06-30 4 D 0 5000 D 2001-10-23 2010-10-23 Common Stock 5000 0 D Stock Option (Right to Buy) 14.00 2004-06-30 4 D 0 5000 D 2002-10-29 2011-10-29 Common Stock 5000 0 D Stock Option (Right to Buy) 4.65 2004-06-30 4 D 0 5000 D 2003-10-28 2012-10-28 Common Stock 5000 0 D Stock Option (Right to Buy) 11.68 2004-06-30 4 D 0 5000 D 2004-10-27 2013-10-27 Common Stock 5000 0 D This option was cancelled in the merger between the issuer and V.F. Corporation in exchange for a cash payment of $64,000, representing the difference between the exercise price of the option and the merger consideration of $20.55 per share. This option was cancelled in the merger between the issuer and V.F. Corporation in exchange for a cash payment of $47,450, representing the difference between the exercise price of the option and the merger consideration of $20.55 per share. This option was cancelled in the merger between the issuer and V.F. Corporation in exchange for a cash payment of $33,700, representing the difference between the exercise price of the option and the merger consideration of $20.55 per share. This option was cancelled in the merger between the issuer and V.F. Corporation in exchange for a cash payment of $32,750, representing the difference between the exercise price of the option and the merger consideration of $20.55 per share. This option was cancelled in the merger between the issuer and V.F. Corporation in exchange for a cash payment of $79,500, representing the difference between the exercise price of the option and the merger consideration of $20.55 per share. This option was cancelled in the merger between the issuer and V.F. Corporation in exchange for a cash payment of $44,350, representing the difference between the exercise price of the option and the merger consideration of $20.55 per share. /s/ Lisa M. Douglas 2004-07-02 -----END PRIVACY-ENHANCED MESSAGE-----