UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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SCHEDULE 13G
(Amendment No. 11)
Under the Securities Exchange Act of 1934
Bush Industries, Inc.
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(Name of Issuer)
Class A Common Stock, $.10 Par Value
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(Title of Class of Securities)
123164 10 5
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(CUSIP Number)
January 3, 2004
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Date of Event Which Requires Filing of this Statement
Check the appropriate box to designate the rule pursuant to which this Schedule
is filed:
|_| Rule 13d-1(b)
|_| Rule 13d-1(c)
|X| Rule 13d-1(d)
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*The remainder of this cover page shall be filled out for a reporting
person's initial filing on this form with respect to the subject class of
securities, and for any subsequent amendment containing information which would
alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not
be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange
Act of 1934 ("Act") or otherwise subject to the liabilities of that section of
the Act but shall be subject to all other provisions of the Act.
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CUSIP NO. 123164 10 5 PAGE 2 OF 9 PAGES
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NAME OF REPORTING PERSONS
1 I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (Entities Only)
Paul S. Bush
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2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a)|_|
(b)|_|
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3 SEC USE ONLY
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CITIZENSHIP OR PLACE OF ORGANIZATION
4
United States
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5 SOLE VOTING POWER
Number of 0
Shares -----------------------------------------
Beneficially 6 SHARED VOTING POWER
Owned by
Each 3,556,577
Reporting -----------------------------------------
Person 7 SOLE DISPOSITIVE POWER
With
0
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8 SHARED DISPOSITIVE POWER
3,556,577
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
3,556,577
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10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES
CERTAIN SHARES
|X|
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
26%
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12 TYPE OF REPORTING PERSON
IN
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CUSIP NO. 123164 10 5 PAGE 3 OF 9 PAGES
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NAME OF REPORTING PERSONS/
1 I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (Entities Only)
Paul S. Bush Declaration of Trust
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2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a)|_|
(b)|_|
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
Florida
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5 SOLE VOTING POWER
Number of 0
Shares -------------------------------------------------
Beneficially
Owned by 6 SHARED VOTING POWER
Each
Reporting 1,096,071
Person --------------------------------------------------
With 7 SOLE DISPOSITIVE POWER
0
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8 SHARED DISPOSITIVE POWER
1,096,071
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
1,096,071
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10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES |_|
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
9.6%
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12 TYPE OF REPORTING PERSON
OO
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CUSIP NO. 123164 10 5 PAGE 4 OF 9 PAGES
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1 NAME OF REPORTING PERSONS
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (Entities Only)
The Bush Family Ltd. Partnership
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2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a)|_|
(b)|_|
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
Florida
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5 SOLE VOTING POWER
Number of 0
Shares ------------------------------------------------
Beneficially
Owned by 6 SHARED VOTING POWER
Each
Reporting 2,261,916
Person ------------------------------------------------
With 7 SOLE DISPOSITIVE POWER
0
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8 SHARED DISPOSITIVE POWER
2,261,916
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
2,261,916
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10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES |_|
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
17.8%
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12 TYPE OF REPORTING PERSON
PN
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CUSIP NO. 123164 10 5 PAGE 5 OF 9 PAGES
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ITEM 1(a). Name of Issuer: Bush Industries, Inc. ("Issuer")
ITEM 1(b). Address of Issuer's Principal Executive Offices:
One Mason Drive, Jamestown, New York 14702
ITEM 2(a). Name of Person Filing
ITEM 2(b). Address of Principal Business Office
ITEM 2(c). Citizenship:
Paul S. Bush
One Mason Drive
Jamestown, New York 14702
United States
Paul S. Bush Declaration of Trust
One Mason Drive
Jamestown, New York 14702
Florida
The Bush Family Ltd. Partnership
One Mason Drive
Jamestown, New York 14702
Florida
ITEM 2(d). Title of Class of Securities:
Class A Common Stock, par value $.10 per share (the "Common
Stock").
ITEM 2(e). Cusip Number: 123164 10 5
ITEM 3. If this statement is filed pursuant to ss.ss.240.13d-1(b)
or 240.13d-2(b) or (c), check whether the person filing is a:
(a) [ ] Broker or dealer registered under section 15 of the
Act (15 U.S.C. 78o).
(b) [ ] Bank as defined in section 3(a)(6) of the Act (15
U.S.C. 78c).
(c) [ ] Insurance company as defined in section 3(a)(19) of
the Act (15 U.S.C.78c).
(d) [ ] Investment company registered under Section 8 of the
Investment Company Act of 1940 (15 U.S.C. 80a-8).
(e) [ ] An investment adviser in accordance with
ss.240.13d-1(b)(1)(ii)(E);
(f) [ ] An employee benefit plan or endowment fund in
accordance with ss.240.13d-1(b)(1)(ii)(F);
(g) [ ] A parent holding company or control person in
accordance with ss.240.13d-1(b)(1)(ii)(G);
(h) [ ] A savings association as defined in Section 3(b) of
the Federal Deposit Insurance Act (12 U.S.C. 1813);
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CUSIP NO. 123164 10 5 PAGE 6 OF 9 PAGES
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(i) [ ] A church plan that is excluded from the definition of
an investment company under section 3(c)(14) of the Investment
Company Act of 1940 (15 U.S.C. 80a-3);
(j) [ ] Group, in accordance with ss.240.13d-1(b)(1)(ii)(J).
N/A
ITEM 4. Ownership.
(a) Amount beneficially owned:
3,556,577 shares of Common Stock (1)
(b) Percent of Class:
26%(1)
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(1) Represents an aggregate 3,556,577 shares of Class A Common Stock
beneficially owned by Paul S. Bush, as to which Mr. Bush may be deemed to share
voting and dispositive power. Such shares include an aggregate 105,759 shares of
Class A Common Stock owned of record by the Paul S. Bush Declaration of Trust
(the "Trust"), and an aggregate 990,312 shares of Class A Common Stock issuable
upon the conversion of a like number of shares of Class B Common Stock owned of
record by the Trust , and as to which Mr. Bush, as the trustee of such Trust,
shares voting and dispositive power with such Trust. In addition, includes an
aggregate 2,261,916 shares of Class A Common Stock issuable upon the conversion
of a like number of shares of Class B Common Stock owned of record by The Bush
Family Ltd. Partnership (the "Partnership"), and as to which Mr. Bush shares
voting and dispositive power with such Partnership. In addition, includes (a) an
aggregate 2,200 shares of Class A Common Stock owned of record by Mr. Bush's
spouse, and an aggregate 2,500 shares of Class A Common Stock issuable upon the
conversion of a like number of shares of Class B Common Stock owned of record by
Mr. Bush's spouse, and with respect to which Mr. Bush disclaims beneficial
ownership, and with respect to which Mr. Bush may be deemed to share voting and
dispositive power; and (b) an aggregate 161,852 shares of Class A Common Stock
owned of record by trusts for Mr. Bush's children and an aggregate 32,038 shares
of Class A Common Stock issuable upon the conversion of a like number of shares
of Class B Common Stock owned of record by such trusts for Mr. Bush's children,
and with respect to which Mr. Bush may be deemed to share voting and dispositive
power. Such shares do not include an aggregate 236,816 shares of Class A Common
Stock owned of record by a Charitable Remainder Unitrust, and with respect to
which Mr. Bush disclaims beneficial ownership. Also excludes an aggregate 11,440
shares of Class Common Stock held of record by the Issuer's 401(k) Plan, and
with respect to such shares the trustees of such Plan have sole voting power.
The afore-described percentages of ownership have been calculated based on an
aggregate 10,385,242 shares of Class A Common Stock outstanding as of January 3,
2004.
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(c) Number of shares as to which such persons have:
(i) Sole power to vote or to direct the vote:
0
(ii) Shared power to vote or to direct the vote:
See Item 4(a) above.
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CUSIP NO. 123164 10 5 PAGE 7 OF 9 PAGES
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(iii) Sole power to dispose or to direct the
disposition of:
0
(iv) Shared power to dispose or to direct the
disposition of:
See Item 4(a) above.
ITEM 5. Ownership of Five Percent or Less of a Class.
N/A
ITEM 6. Ownership of More Than Five Percent on Behalf of Another Person.
See Item 4(a) above.
ITEM 7. Identification and Classification of the Subsidiary Which
Acquired the Security Being Reported On By the Parent Holding
Company or Control Person.
N/A
ITEM 8. Identification and Classification of Members of the Group.
N/A
ITEM 9. Notice of Dissolution of Group.
N/A
ITEM 10. Certifications.
N/A
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CUSIP NO. 123164 10 5 PAGE 8 OF 9 PAGES
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SIGNATURES
After reasonable inquiry and to the best of my knowledge and belief, I certify
that the information set forth in this statement is true, complete and correct.
Dated: February 16, 2004 By: /s/ Paul S. Bush
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Paul S. Bush
Paul S. Bush Declaration of Trust
Dated: February 16, 2004 By: /s/ Paul S. Bush
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Paul S. Bush,
Trustee
The Bush Family Ltd. Partnership
By: Bush Enterprises, Inc., General
Partner
Dated: February 16, 2004 By: /s/ Paul S. Bush, President
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By: Paul S. Bush, President
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CUSIP NO. 123164 10 5 PAGE 9 OF 9 PAGES
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EXHIBIT A
JOINT FILING AGREEMENT
In accordance with Rule 13d-1(k)(1) under the Securities Exchange Act
of 1934, the undersigned hereby agree to the joint filing with all other
Reporting Persons (as such term is used in Amendment No. 11 to the Schedule
13G/A referred to below) on behalf of each of them of a statement on Amendment
No. 11 to Schedule 13G/A (including amendments thereto) with respect to the
Common Stock, par value $.10 per share, of Bush Industries, Inc. and that this
Agreement be included as an Exhibit to such joint filing. This Agreement may be
executed in any number of counterparts all of which taken together shall
constitute one and the same instrument.
IN WITNESS WHEREOF, the undersigned hereby execute this Agreement this
16 day of February, 2004.
Dated: February 16, 2004 By: /s/ Paul S. Bush
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Paul S. Bush
Paul S. Bush Declaration of Trust
Dated: February 16, 2004 By: /s/ Paul S. Bush
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Paul S. Bush,
Trustee
The Bush Family Ltd. Partnership
By: Bush Enterprises, Inc., General
Partner
Dated: February 16, 2004 By: /s/ Paul S. Bush, President
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By: Paul S. Bush, President