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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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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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 2270 (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 at End of Issuer's Fiscal Year (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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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Common Stock | (2) | (2) | Common | 12,000 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
PRINTZ HOWARD L 50 PAGE ROAD CLIFTON, NJ 07012 |
President of Division |
/s/ Cheryl C. Carter, Power of Attorney for Howard L.l Printz | 01/24/2005 | |
**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). |
(1) | Between January 1 and December 31, 2004, the reporting person acquired 1,223 shares of Synalloy common stock under the Synalloy Corporation 401(k)/ESOP. The information in this report is based on a plan statement dated as of December 31, 2004. |
(2) | Reporting person was granted 12,000 options at an exercise price of $5.822 per share on July 25, 2003 and reported on Form 3 dated 2/9/2004 upon reporting person becoming an officer of a subsidiary. The options vest in five equal installments of 20% beginning one year from date of grant. |