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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 | ||||||||
Class B Stock | $ 0 | (1) | (1) | Common Stock | 301 | 301 | D | ||||||||
Class B Stock | $ 0 | (1) | (1) | Common Stock | 22,366 | 22,366 | I | By Spouse | |||||||
Class B Stock | $ 0 | 01/03/2005 | G(2) | V | 1,736.9 | (1) | (1) | Common Stock | 1,736.9 | (1) | 23,773.59 | I | By Spouse as Trustee1 (3) | ||
Class B Stock | $ 0 | 01/03/2005 | G(2) | V | 1,736.9 | (1) | (1) | Common Stock | 1,736.9 | (1) | 23,773.59 | I | By Spouse as Trustee2 (4) | ||
Class B Stock | $ 0 | 01/03/2005 | G(2) | V | 1,736.9 | (1) | (1) | Common Stock | 1,736.9 | (1) | 23,773.59 | I | By Spouse as Trustee3 (5) | ||
Class B Stock | $ 0 | 01/03/2005 | G(2) | V | 1,736.9 | (1) | (1) | Common Stock | 1,736.9 | (1) | 23,773.59 | I | By Spouse as Trustee4 (6) | ||
Class B Stock | $ 0 | 01/03/2005 | G(2) | V | 1,736.9 | (1) | (1) | Common Stock | 1,736.9 | (1) | 23,773.59 | I | By Spouse as Trustee5 (7) | ||
Class B Stock | $ 0 | 01/03/2005 | G(2) | V | 1,736.9 | (1) | (1) | Common Stock | 1,736.9 | (1) | 64,569.18 | I | By Spouse1 (8) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
COFSKY THOMAS F 410 N. MICHIGAN AVE. SUITE 400 CHICAGO, IL 60611-4213 |
Vice President |
Maryon Gray by Power of Attorney | 01/05/2005 | |
**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). |
(6) | Spouse as Trustee of Joseph Michael Cofsky Minority Trust. 22,273.6 of the shares reported are interest of the Trust in the Jaffee Investment Partnership. |
(1) | Class B Stock may be converted at any time at the option of the holder into Common Stock on a share for share basis. See note 134 to SEC Release 34-288691 |
(4) | Spouse as Trustee of James Andrew Cofsky Minority Trust. 22,273.6 of the shares reported are interest of the Trust in the Jaffee Investment Partnership. |
(3) | Spouse as Trustee of Jennifer Helen Cofsky Minority Trust. 22,273.6 of the shares reported are interest of the Trust in the Jaffee Investment Partnership. |
(8) | Interest of Spouse of Reporting Person in Jaffee Investment Partnership, L.P. (a family partnership) |
(7) | Spouse as Trustee of Jacqueline Rachel Cofsky Minority Trust. 22,273.6 of the shares reported are interest of the Trust in the Jaffee Investment Partnership. |
(5) | Spouse as Trustee of Jeffrey Daniel Cofsky Minority Trust. 22,273.6 of the shares reported are interest of the Trust in the Jaffee Investment Partnership. |
(2) | Gift of interest in the Jaffee Investment Partnership, L.P. (a family partnership). |