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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, 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 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 | |||||||||
Non-qualified stock options (1) | $ 9.92 | 09/17/1997 | Â | A | 0 | Â | 09/17/1997 | 10/17/2007 | Common Stock | $ 0 | 21,500 | Â | ||
Non-qualified stock options (2) | $ 14 | 09/09/1998 | Â | A | 0 | Â | 09/09/1998 | 10/09/2008 | Common Stock | $ 0 | 36,500 | Â | ||
Non-qualified stock options | $ 15.25 | 12/15/1999 | Â | A | 0 | Â | 12/15/1999 | 01/15/2010 | Common Stock | $ 0 | 49,000 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HENRY CHARLES W 112 BRIDGE STREET NAUGATUCK, CT 06770 |
 X |  |  |  |
Charles W. Henry, by John L. Sullivan III, his attorney-in-fact | 01/14/2005 | |
**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) | Original 9/17/1997 option was for 15,000 shares at $14.875 per share. As a result of a 3-for-2 stock split effective 5/28/1999 this option became an option for 22,500 shares at $9.92 per share. On 1/19/00, 1,000 options were exercised, leaving a balance of 21,500 options. |
(2) | Original 9/9/1998 option was for 10,000 shares at $21.00 per share. As a result of a 3-for-2 stock split effective 5/28/1999 this option is now 15,000 shares at $14.00 per share. |