SEC FORM
4
SEC Form 4
| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|
| OMB APPROVAL |
| OMB Number: |
3235-0287 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
 |
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
JOHNSON OUTDOORS INC
[ JOUT ]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
X |
10% Owner |
|
Officer (give title below) |
|
Other (specify below) |
|
|
3. Date of Earliest Transaction
(Month/Day/Year)
02/20/2003
|
4. If Amendment, Date of Original Filed
(Month/Day/Year)
|
6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
|
Form filed by More than One Reporting Person |
|
| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
|---|
| 1. Title of Security (Instr.
3)
|
2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
|
4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
|
5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
|
6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
|
7. Nature of Indirect Beneficial Ownership (Instr.
4)
|
| Code |
V |
Amount |
(A) or (D) |
Price |
| Class A Common Stock |
02/20/2003 |
|
A |
|
966 |
A |
0.00 |
3,018,427
|
I |
By Husband
|
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr.
4)
|
11. Nature of Indirect Beneficial Ownership (Instr.
4)
|
| Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
|
Option (right to buy)
|
10.36 |
02/20/2003 |
|
A |
|
4,150 |
|
02/20/2004 |
02/20/2013 |
Class A Common Stock |
4,150 |
$0.00
|
4,150 |
I |
By Husband
|
|
Option (obligation to sell)
|
13.04 |
07/08/2003 |
|
S |
|
|
970,001 |
07/08/2003 |
01/07/2005 |
Class A Common Stock |
970,001 |
$2.31
|
0 |
I |
By Husband
|
| Explanation of Responses: |
|
|
|
|
|
Linda L. Sturino, attorney-in-fact |
07/09/2003 |
|
Jane M. Hutterly, attorney-in-fact |
07/09/2003 |
|
** Signature of Reporting Person |
Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * 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). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| 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 Number. |
WISCONSIN STATUTORY POWER OF ATTORNEY
NOTICE: THIS IS AN IMPORTANT DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU
SHOULD KNOW THESE IMPORTANT FACTS. BY SIGNING THIS DOCUMENT, YOU ARE NOT GIVING
UP ANY POWERS OR RIGHTS TO CONTROL YOUR FINANCES AND PROPERTY YOURSELF. IN
ADDITION TO YOUR OWN POWERS AND RIGHTS, YOU ARE GIVING ANOTHER PERSON, YOUR
AGENT, BROAD POWERS TO HANDLE YOUR FINANCES AND PROPERTY. THIS BASIC POWER OF
ATTORNEY FOR FINANCES AND PROPERTY MAY GIVE THE PERSON WHOM YOU DESIGNATE (YOUR
"AGENT") BROAD POWERS TO HANDLE YOUR FINANCES AND PROPERTY, WHICH MAY INCLUDE
POWERS TO ENCUMBER, SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY
WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THE POWERS WILL EXIST AFTER
YOU BECOME DISABLED, OR INCAPACITATED, IF YOU CHOOSE THAT PROVISION. THIS
DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH CARE
DECISIONS FOR YOU. IF YOU OWN COMPLEX OR SPECIAL ASSETS SUCH AS A BUSINESS, OR
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK
A LAWYER TO EXPLAIN THIS FORM TO YOU BEFORE YOU SIGN IT.
IF YOU WISH TO CHANGE YOUR BASIC POWER OF ATTORNEY FOR FINANCES AND
PROPERTY, YOU MUST COMPLETE A NEW DOCUMENT AND REVOKE THIS ONE. YOU MAY REVOKE
THIS DOCUMENT AT ANY TIME BY DESTROYING IT, BY DIRECTING ANOTHER PERSON TO
DESTROY IT IN YOUR PRESENCE OR BY SIGNING A WRITTEN AND DATED STATEMENT
EXPRESSING YOUR INTENT TO REVOKE THIS DOCUMENT. IF YOU REVOKE THIS DOCUMENT, YOU
SHOULD NOTIFY YOUR AGENT AND ANY OTHER PERSON TO WHOM YOU HAVE GIVEN A COPY OF
THE FORM. YOU ALSO SHOULD NOTIFY ALL PARTIES HAVING CUSTODY OF YOUR ASSETS.
THESE PARTIES HAVE NO RESPONSIBILITY TO YOU UNLESS YOU ACTUALLY NOTIFY THEM OF
THE REVOCATION. IF YOUR AGENT IS YOUR SPOUSE AND YOUR MARRIAGE IS ANNULLED, OR
YOU ARE DIVORCED AFTER SIGNING THIS DOCUMENT, THIS DOCUMENT IS INVALID.
SINCE SOME THIRD PARTIES OR SOME TRANSACTIONS MAY NOT PERMIT USE OF THIS
DOCUMENT, IT IS ADVISABLE TO CHECK IN ADVANCE, IF POSSIBLE, FOR ANY SPECIAL
REQUIREMENTS THAT MAY BE IMPOSED.
YOU SHOULD SIGN THIS FORM ONLY IF THE AGENT YOU NAME IS RELIABLE,
TRUSTWORTHY AND COMPETENT TO MANAGE YOUR AFFAIRS.
I, IMOGENE POWERS JOHNSON, of the Village of Wind Point, Racine County,
Wisconsin, appoint my son, H. FISK JOHNSON, of Chicago, Illinois, JANE M.
HUTTERLY, of Racine, Wisconsin, and LINDA L. STURINO, of Racine, Wisconsin, as
my agents (my "co-agents"), all of whom are collectively referred to herein as
my "agent," to act for me in any lawful way with respect to the powers initialed
below. If more than one agent is named to act hereunder, such co-agents shall
act by majority. If any of the named co-agents shall die, become incompetent,
resign, or refuse to accept the office of agent, or is otherwise
unable or unwilling to act, then the remaining co-agents or co-agent shall act.
During any period in which more than one agent is acting hereunder, the
following provisions shall be applicable where the context admits: (a) any agent
may delegate any part or all of the rights, powers, duties, discretions and
immunities granted to or imposed upon such agent by this instrument to any other
agent, with the consent of the latter; (b) no agent shall be liable or
responsible for any act or failure to act of the other agent in which the former
has not concurred; (c) the co-agents may execute any instrument or document in
connection with the purposes of this instrument by signing one document or
instrument or concurrent documents or instruments; and (d) the affidavit of any
agent shall be conclusive evidence insofar as third parties are concerned that
any act of such agent has been duly authorized.
TO GRANT ONE OR MORE OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF
EACH POWER YOU ARE GRANTING.
TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU MAY, BUT
NEED NOT, CROSS OUT EACH POWER WITHHELD.
. . .
GENERAL AUTHORITY
Initials
/s/ IPJ 12. GENERAL: My agent may do any act or thing that I could do in my own
proper person if personally present, including managing or selling tangible
assets, disclaiming a probate or nonprobate inheritance and providing support
for a minor child or dependent adult. The specifically enumerated powers of the
basic power of attorney for finances and property are not a limitation of this
intended broad general power except that my agent may not take any action
prohibited by law and my agent under this document may not:
a. Make medical or health care decisions for me.
b. Make, modify or revoke a will for me.
c. Other than a burial trust agreement under section 445.125,
Wisconsin Statutes, enter into a trust agreement on my behalf or amend or
revoke a trust agreement, entered into by me.
d. Change any beneficiary designation of any life insurance policy,
qualified retirement plan, individual retirement account or payable on
death account or the like whether directly or by canceling and replacing
the policy or rollover to another plan or account.
e. Forgive debts owed to me or disclaim or waive benefits payable to
me, except a probate or nonprobate inheritance.
f. Appoint a substitute or successor agent for me.
g. Make gifts.
2
. . .
I agree that any third party who receives a copy of this document may act
under it. Revocation of this basic power of attorney is not effective as to a
third party until the third party learns of the revocation. I agree to reimburse
the third party for any loss resulting from claims that arise against the third
party because of reliance on this power of attorney.
Signed this 6 day of June, 2003.
/s/ Imogene Powers Johnson
------------------------------------
Name
[Social Security Number]
------------------------------------
Social Security Number
By signing as a witness, I am acknowledging the signature of the principal
who signed in my presence and the presence of the other witness, and the fact
that the principal has stated that this power of attorney reflects the
principals wishes and is being executed voluntarily. I believe the principal to
be of sound mind and capable of creating this power of attorney. I am not
related to the principal by blood or marriage, or adoption, and, to the best of
my knowledge, I am not entitled to any portion of the principal's estate under
the principal's will.
Witness: /s/ Linda L. Sturino
------------------------------
Dated: June 6, 2003
------------------------------
By: ------------------------------
Print Name: Linda L. Sturino
---------------------------
Address: [Address]
------------------------------
------------------------------
Witness: /s/ Stephen M. Chiles
------------------------------
Dated: June 6, 2003
------------------------------
By: ------------------------------
Print Name: Stephen M. Chiles
---------------------------
Address: [Address]
------------------------------
------------------------------
3
State of Wisconsin )
County of Racine )
This document was acknowledged before me on June 6, 2003 by
IMOGENE POWERS JOHNSON.
/s/ Joyce A. Onosko
------------------------------------
(Signature of Notarial Officer)
(Seal, if any)
(Title)
My commission is permanent or expires: 3/4/07
------
BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, EACH AGENT ASSUMES THE
FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.
H. FISK JOHNSON
------------------------------------
Agent
/s/ H. Fisk Johnson
------------------------------------
(Signature of Agent)
JANE M. HUTTERLY
-----------------------------------
Agent
/s/ Jane M. Hutterly
------------------------------------
(Signature of Agent)
LINDA L. STURINO
------------------------------------
Agent
/s/ Linda L. Sturino
------------------------------------
(Signature of Agent)
4
