UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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SCHEDULE 13G
(Amendment No. 1)
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:
|X| Rule 13d-1(b)
|_| Rule 13d-1(c)
|_| Rule 13d-1(d)
*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 13G Page 2 of 5 Pages
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1 NAME OF REPORTING PERSONS
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (Entities Only)
Bush Industries, Inc. Savings and Retirement Plan
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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
New York
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5 SOLE VOTING POWER
Number of 657,845
Shares
Beneficially --------- ----------------------------------------------------------------------------------------
Owned by
Each 6 SHARED VOTING POWER
Reporting
Person -
With --------- ----------------------------------------------------------------------------------------
7 SOLE DISPOSITIVE POWER
-
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8 SHARED DISPOSITIVE POWER
657,845
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
657,845
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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)
6.33%
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12 TYPE OF REPORTING PERSON
EP
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CUSIP No. 123164 10 5 13G Page 3 of 5 Pages
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Item 1(a). Name of Issuer: Bush Industries, Inc.
Item 1(b). Address of Issuer's Principal Executive Offices:
One Mason Drive
Jamestown, New York 14702
Item 2(a). Name of Person Filing:
Bush Industries, Inc. Savings and Retirement Plan (the "Plan")
Item 2(b). Address of Principal Business Office or, if none, Residence:
One Mason Drive
Jamestown, New York 14702
Item 2(c). Citizenship: New York
Item 2(d). Title of Class of Securities: Class A Common Stock, $.10 par
value per share (the "Class A 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) [ x ] 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 is defined in Section 3(b) of the
Federal Deposit Insurance Act (12 U.S.C. 1813).
(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).
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CUSIP No. 123164 10 5 13G Page 4 of 5 Pages
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(j) [ ] Group, in accordance with ss.240.13d-1(b)(1)(ii)(J).
Item 4. Ownership.
(a) Amount beneficially owned: 657,845(1)
(b) Percent of class: 6.33%(1)
(c) Number of shares as to which such person has:
(i) Sole power to vote or to direct the vote 657,845(1)
(ii) Shared power to vote or to direct the vote: 0
(iii) Sole power to dispose or to direct the disposition
of: 0
(iv) Shared power to dispose or to direct the disposition
of: 657,845(1)
Item 5. Ownership of Five Percent or Less of a Class.
Not Applicable
Item 6. Ownership of More than Five Percent on Behalf of Another Person.
Not Applicable
Item 7. Identification and Classification of the Subsidiary Which
Acquired the Security Being Reported on by the Parent Holding
Company or Control Person.
Not Applicable
Item 8. Identification and Classification of Members of the Group.
Not Applicable
Item 9. Notice of Dissolution of Group.
Not Applicable
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(1) Based on an aggregate 10,385,242 shares of Class A Common Stock outstanding
as of January 3, 2004. With respect to the shares beneficially owned by the
Plan, the Plan may be deemed to have sole voting and may be deemed to share
dispositive power with the participants in the Plan.
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CUSIP No. 123164 10 5 13G Page 5 of 5 Pages
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Item 10. Certifications.
By signing below I certify that, to the best of my knowledge and
belief, the securities referred to above were acquired and are held in the
ordinary course of business and were not acquired and are not held for the
purpose of or with the effect of changing or influencing the control of the
issuer of the securities and were not acquired and are not held in connection
with or as a participant in any transaction having that purpose or effect.
SIGNATURE
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.
Bush Industries, Inc. Savings and
Retirement Plan
By: Bush Industries, Inc.
Date: February 16, 2004 By: /s/ Neil A. Frederick
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Neil A. Frederick
Treasurer