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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MILSTEIN MONROE G C/O BURLINGTON COAT FACTORY 1830 ROUTE 130 BURLINGTON, NJ 08016 |
X | X | President, CEO and Chairman |
Paul C. Tang, by power of attorney previously filed | 12/08/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Represents shares of common stock that the reporting person transferred by gift to the MM 2005 Intangibles Trust, of which the reporting person is the settlor and beneficiary and the reporting person's son is the trustee. The reporting person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. |
(2) | Represents shares owned by the Estate of Henrietta Milstein. As executor of the Estate, the reporting person has voting and dispositive power over these shares, but disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. |
(3) | Includes 6,743,984 shares held by the Trust Established Under Article SIXTH of the Last Will and Testament of Henrietta Milstein (the "Trust"). The reporting person may be deemed to have an indirect beneficial interest in the shares owned by the Trust because the reporting person is a beneficiary under the Trust and has limited dispositive rights with respect to the shares owned by the Trust. The reporting person disclaims any such interest. Also includes 11,772,216 shares representing the reporting person's proportionate interest in 12,000,000 shares held by Samgray, L.P. The reporting person is a limited partner in Samgray, L.P., and members of the reporting person's family control the general partner of Samgray, L.P. |