- Annual Statement of Changes in Beneficial Ownership (5)
February 04 2011 - 5:30PM
Edgar (US Regulatory)
FORM 5
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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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Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Expires:
February 28, 2011
Estimated average burden
hours per response...
1.0
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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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
SMITH THOMAS W
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2. Issuer Name
and
Ticker or Trading Symbol
PRE PAID LEGAL SERVICES INC [PPD]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
__
X
__ Other (specify below)
Member of Section 13D Group
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(Last)
(First)
(Middle)
323 RAILROAD AVENUE
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2010
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(Street)
GREENWICH, CT 06830
(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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Amount
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(A) or (D)
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Price
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Common Stock
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12/29/2010
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G
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100000
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D
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$0
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655900
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D
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Common Stock
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100000
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I
(1)
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By Thomas W. Smith Foundation
(1)
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Common Stock
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488434
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I
(2)
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By Idoya Partners L.P.
(2)
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Common Stock
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1014675
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I
(3)
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By Prescott Associates L.P.
(3)
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Common Stock
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41306
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I
(4)
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By Prescott International Partners L.P.
(4)
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Common Stock
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65000
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I
(5)
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By Prescott Investors Profit Sharing Trust
(5)
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Table II - Derivative Securities Acquired, Disposed of, or 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
(MM/DD/YYYY)
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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 at End of Issuer's Fiscal Year
(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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(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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Explanation of Responses:
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(
1)
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These shares are owned directly by the Thomas W. Smith Foundation ("Foundation") and indirectly by the Reporting Person as
trustee of the Foundation. The Reporting Person disclaims beneficial ownership of these shares in excess of his pencuniary
interest under 16a-8(b)(2)(ii). The address for the Foundation is 323 Railroad Avenue, Greenwich, CT 06830.
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(
2)
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These shares are owned directly by Idoya Partners L.P. ("Idoya"), a private investment limited partnership, and indirectly by
the Reporting Person as general partner of Idoya. The Reporting Person disclaims beneficial ownership of these shares in
excess of his pencuniary interest under Rule 16a-1(a)(2)(ii)(B). The address for Idoya is 323 Railroad Avenue, Greenwich, CT
06830.
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(
3)
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These shares are owned directly by Prescott Associates L.P. ("Prescott Associates"), a private investment limited
partnership, and indirectly by the Reporting Person as general partner of Prescott Associate. The Reporting Person disclaims
beneficial ownership of these shares in excess of his pencuniary interest under Rule 16a-1(a)(2)(ii)(B). The address for
Prescott Associates is 323 Railroad Avenue, Greenwich, CT 06830.
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(
4)
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These shares are owned directly by Prescott International Partners L.P. ("PIP"), a private investment limited partnership,
and indirectly by the Reporting Person as general partner of PIP. The Reporting Person disclaims beneficial ownership of
these shares in excess of his pencuniary interest under Rule 16a-1(a)(2)(ii)(B). The address for PIP is 323 Railroad Avenue,
Greenwich, CT 06830.
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(
5)
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These shares are owned directly by the Prescott Investors Profit Sharing Trust ("Trust") and indirectly by the Reporting
Person as a trustee of the Trust. The Reporting Person disclaims beneficial ownership of these shares in excess of his
pencuniary interest under 16a-8(b)(2)(ii). The address for the Trust is 323 Railroad Avenue, Greenwich, CT 06830.
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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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SMITH THOMAS W
323 RAILROAD AVENUE
GREENWICH, CT 06830
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X
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Member of Section 13D Group
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Signatures
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/s/ Thomas W. Smith
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2/4/2011
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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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