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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 | 26,966 | 26,966 | D | ||||||||
Class B Stock | $ 0 | (1) | (1) | Common Stock | 2 | 2 | I | By Spouse | |||||||
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 | Partnership (3) | ||
Class B Stock | $ 0 | (1) | (1) | Common Stock | 1,102 | 1,102 | I | Trustee1 | |||||||
Class B Stock | $ 0 | (1) | (1) | Common Stock | 1,117 | 1,117 | I | Trustee2 | |||||||
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 | Trustee3 (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 | Trustee4 (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 | Trustee5 (6) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
JAFFEE DANIEL S 410 N. MICHIGAN AVE. SUITE 400 CHICAGO, IL 60611-4213 |
X | President and CEO |
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) | Reporting Person as Trustee of Nathaniel Charles Jaffee Minority Trust. 22,273.6 of the shares reported are interest in the Minority Trust in the Jaffee Investment Partnership. |
(3) | Interest of Reporting Person in Jaffee Investment Partnership, L.P. (a family 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) | Reporting Person as Trustee of Claire Miller Jaffee Minority Trust. 22,273.6 of the shares reported are interest of the Minority Trust in the Jaffee Investment Partnership. |
(2) | Gift of interest in the Jaffee Investment Partnership, L.P. (a family partnership). |
(5) | Reporting Person as Trustee of Elise Miller Jaffee Minority Trust. 22,273.6 of the shares reported are interest of the Minority Trust in the Jaffee Investment Partnership. |