-----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, FXH6M6oGAvvOpii9ev13UTGY/GnMkAddo6H/3T8ucsMEK2CG3WXs9BLBR0S9cYmq Qtj5ep3GtvZg2FZVAXA8jA== 0000897069-03-000232.txt : 20030214 0000897069-03-000232.hdr.sgml : 20030214 20030214173025 ACCESSION NUMBER: 0000897069-03-000232 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030214 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: SISLER ANDREW M CENTRAL INDEX KEY: 0001207261 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 5 MAIL ADDRESS: STREET 1: BANDAG INC STREET 2: 2905 N HWY 61 CITY: MUSCATINE STATE: IA ZIP: 52761 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BANDAG INC CENTRAL INDEX KEY: 0000009534 STANDARD INDUSTRIAL CLASSIFICATION: TIRES AND INNER TUBES [3011] IRS NUMBER: 420802143 STATE OF INCORPORATION: IA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07007 FILM NUMBER: 03568446 BUSINESS ADDRESS: STREET 1: 2905 NORTH HIGHWAY 61 STREET 2: BANDAG HEADQUARTERS CITY: MUSCATINE STATE: IA ZIP: 52761-5886 BUSINESS PHONE: 3192621400 MAIL ADDRESS: STREET 1: 2905 N HIGHWAY 61 STREET 2: BANDAG HEADQUARTERS CITY: MUSCATINE STATE: IA ZIP: 52761-5886 5 1 sdc322.txt FORM 5 - BANDAG - SISLER ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0362 Expires: January 31, 2005 Estimated average burden hours per response ....... 1.0 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 5 ANNUAL 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). [_] Form 3 Holdings Reported [_] Form 4 Transactions Reported ________________________________________________________________________________ 1. Name and Address of Reporting Person* Sisler, Andrew M. - -------------------------------------------------------------------------------- (Last) (First) (Middle) Bandag, Incorporated 2905 North Highway 61 - -------------------------------------------------------------------------------- (Street) Muscatine, IA 52761-5886 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Bandag, Incorporated (BDG) and (BDGA) ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year December 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [_] Director [_] 10% Owner [X] Officer (give title below) [_] Other (specify below) Vice President, North American Franchise Sales ________________________________________________________________________________ 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 ====================================================================================================================================
5. 6. 4. Amount of Owner- 2A.Deemed Securities Acquired (A) or Securities ship 2. Execution Disposed of (D) Beneficially Form: 7. Transaction Date, (Instr. 3, 4 and 5) Owned at End Direct Nature of Date if any 3. ------------------------------- of Issuer's (D) or Indirect 1. (Month/ (Month/ Transaction (A) Fiscal Year Indirect Beneficial Title of Security Day/ Day/ Code Amount or Price (Instr. 3 (I) Ownership (Instr. 3) Year) Year) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, (1)(2) $1.00 Par Value 460.9675 D - ------------------------------------------------------------------------------------------------------------------------------------ Class A Common Stock, (1)(2) $1.00 Par Value 469.3732 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Persons who respond to the collection of information contained in this form are not required to respond (Over) unless the form displays a currently valid OMB SEC 2270 (7-02) control number. FORM 5 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ====================================================================================================================================
9. 10. Number Owner- of ship 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or 3A. Derivative 6. of Underlying 8. ities Secur- of Exer- Deemed Securities Date Securities Price Bene- ity: In- cise 3. Execu- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- tion 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Date, Trans- of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date if any action (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship Security Secur- Day/ Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ By Profit Stock Common (4) (4) Sharing Fund Unit (3) (3) Stock 122.9210 122.9210 I Plan - ------------------------------------------------------------------------------------------------------------------------------------ By Class A Profit Stock Common (4) (4) Sharing Fund Unit (3) (3) Stock 145.2340 145.2340 I Plan - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option Class A (Right Common to Buy) 21.09375 (5) 3/7/10 Stock 10,400 10,400 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option Class A (Right Common to Buy) 24.35 (6) 3/13/11 Stock 7,400 7,400 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option Class A (Right Common to Buy) 32.53 (7) 3/12/12 Stock 8,600 8,600 D ==================================================================================================================================== Explanation of Responses: (1) Column 5 of Table I includes 13.1215 shares of Common Stock and 15.1086 shares of Class A Common Stock acquired through automatic reinvestment of dividends under the Bandag, Incorporated Dividend Reinvestment and Optional Cash Purchase Plan ("DRP") since March 29, 2002. (2) Andrew M. Sisler participates in the Bandag, Incorporated Restricted Stock Grant Plan ("Plan"). Column 5 of Table I includes 385 shares of Common Stock and 385 shares of Class A Common Stock held by Mr. Sisler under the Plan. The shares are restricted for 7 years when granted and are held by a Trustee for the benefit of Mr. Sisler. (3) Represents stock fund units under the Bandag Salaried Profit Sharing, Retirement and Savings Plan ("Profit Sharing Plan"). Distributions will be made upon the earliest to occur of termination of employment, death or retirement, subject to limited exceptions. (4) The number of underlying securities is based on the number of stock fund units, the value of these units and the Company's Common and Class A Common Stock market values as of December 31, 2002. The actual number of shares issuable upon the distribution date is not determinable since the stock fund is a unitized account consisting of Company stock and other investments. (5) Options for 10,400 shares of Class A Common Stock with 20% vesting (2,080 shares) on each of March 7, 2001, 2002, 2003, 2004, 2005. (6) Options for 7,400 shares of Class A Common Stock with 20% vesting (1,480 shares) on each of March 13, 2002, 2003, 2004, 2005, 2006. (7) Options for 8,600 shares of Class A Common Stock with 25% vesting (2,150 shares) on each of March 12, 2003, 2004, 2005, 2006. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Andrew M. Sisler 2/4/03 ----------------------------------- ---------- See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date Andrew M. Sisler 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
POWER OF ATTORNEY Know all by these presents, that, for good and valuable consideration, the sufficiency and receipt of which are hereby acknowledged, the undersigned hereby constitutes and appoints each of Warren W. Heidbreder, Janet M. Henderson and Barbara T. Soenksen, and any of their substitutes, signing singly, the undersigned's true and lawful attorney-in-fact to: (1) execute for and on behalf of the undersigned (in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended, and the rules thereunder (the "Exchange Act")), in the undersigned's capacity as an officer of Bandag, Incorporated, an Iowa corporation (the "Company"), any and all Forms 3, 4 and/or 5, and any amendments thereto, that are necessary or advisable for the undersigned to file under Section 16(a) (collectively, "Documents"); (2) do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to complete and execute any such Documents and timely file such Documents with the United States Securities and Exchange Commission and any stock exchange or similar 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 the documents executed by such attorney-in-fact on behalf of the undersigned 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 such attorney-in-fact's discretion. The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary or 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 each such attorney-in-fact (or such attorney-in-fact's substitute or substitutes) shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that each attorney-in-fact, in serving in such capacity at the request of the undersigned, is not assuming, nor is such attorney-in-fact's substitute or substitutes or the Company assuming, any of the undersigned's responsibilities to comply with the Exchange Act. The undersigned agrees to defend and hold harmless each attorney-in-fact (and such attorney-in-fact's substitute or substitutes) from and against any and all loss, damage or liability that such attorney-in-fact may sustain as a result of any action taken in good faith hereunder. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Documents with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to each of the foregoing attorneys-in-fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 8th day of November, 2002. /s/ Andrew M. Sisler ---------------------------------------- Signature - Andrew M. Sisler -----END PRIVACY-ENHANCED MESSAGE-----