SEC FORM 3/A SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF 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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1. Name and Address of Reporting Person*
TRUSSELL ROBERT B JR

(Last) (First) (Middle)
C/O TEMPUR-PEDIC INTERNATIONAL INC.
1713 JAGGIE FOX WAY

(Street)
LEXINGTON KY 40511

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/17/2003
3. Issuer Name and Ticker or Trading Symbol
TEMPUR PEDIC INTERNATIONAL INC [ TPX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President, CEO, Director
5. If Amendment, Date of Original Filed (Month/Day/Year)
12/17/2003
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Class A Common Stock, $0.01 par value per share(1) (2) (2) Class B-1 Voting Common Stock, $0.01 par value per share 2,101.42 (4) D(3)
Class A Common Stock, $0.01 par value per share(1) (2) (2) Class B-1 Voting Common Stock, $0.01 par value per share 3,153 (4) I By RBT Investments LLC
Explanation of Responses:
1. These securities were initially reported as Non-Derivative Securities in Table I of the reporting person's original Form 3. Shares of Class A Common Stock are convertible into shares of Class B-1 Voting Common Stock on a one-for-one basis.
2. These securities are Class A Common Stock of the Issuer. As such, they are convertible at any time and do not have an expiration date.
3. These shares are owned by Robert B. Trussell, Jr. and Martha O. Trussell as Tenants in Common.
4. 1-for-1
/s/ William H. Poche, Attorney-in-fact 12/24/2003
** 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 5 (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.
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