Statement of Changes in Beneficial Ownership (4)
August 21 2015 - 5:03PM
Edgar (US Regulatory)
FORM 4
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
DANNA LEONARD P
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2. Issuer Name
and
Ticker or Trading Symbol
COAST DISTRIBUTION SYSTEM INC
[
CRV
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
350 WOODVIEW AVENUE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
8/19/2015
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(Street)
MORGAN HILL, CA 95037
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option (Right to Buy)
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$4.90
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8/19/2015
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D
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2000
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3/3/2006
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8/31/2015
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Common Stock
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2000
(1)
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$0.00
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0
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D
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Employee Stock Option (Right to Buy)
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$3.10
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8/19/2015
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D
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2000
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2/28/2009
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8/28/2018
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Common Stock
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2000
(1)
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$0.00
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0
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D
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Employee Stock Option (Right to Buy)
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$2.77
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8/19/2015
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D
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2000
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2/25/2010
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8/25/2019
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Common Stock
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2000
(1)
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$0.00
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0
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D
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Employee Stock Option (Right to Buy)
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$4.25
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8/19/2015
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D
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2000
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2/10/2011
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8/10/2020
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Common Stock
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2000
(1)
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$0.00
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0
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D
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Employee Stock Option (Right to Buy)
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$2.74
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8/19/2015
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D
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2000
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2/23/2012
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8/23/2021
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Common Stock
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2000
(1)
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$0.00
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0
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D
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Employee Stock Option (Right to Buy)
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$1.80
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8/19/2015
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D
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2000
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2/28/2013
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8/28/2022
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Common Stock
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2000
(1)
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$0.00
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0
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D
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Employee Stock Option (Right to Buy)
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$3.87
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8/19/2015
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D
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2000
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2/27/2014
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8/27/2023
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Common Stock
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2000
(1)
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$0.00
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0
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D
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Employee Stock Option (Right to Buy)
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$3.30
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8/19/2015
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D
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2000
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2/26/2015
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8/26/2024
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Common Stock
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2000
(1)
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$0.00
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0
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D
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Explanation of Responses:
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(
1)
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Each of these options was cancelled pursuant to the terms of the Agreement and Plan of Merger, dated as of July 8, 2015, by and among LKQ Corporation, Keystone Automotive Operations, Inc., KAO Acquisition Sub, Inc. and the issuer, in exchange for a cash payment, on August 19, 2015, in an amount equal to the difference between $5.50 per share and the respective per share exercise prices of the options.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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DANNA LEONARD P
350 WOODVIEW AVENUE
MORGAN HILL, CA 95037
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X
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Signatures
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/s/ Leonard P. Danna
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8/21/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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