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
 
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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*
BRYANT H THOMAS

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

(Street)
LEXINGTON KY 40511

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
TEMPUR PEDIC INTERNATIONAL INC [ TPX ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Exec. VP, Pres. N. Amer. Ops.
3. Date of Earliest Transaction (Month/Day/Year)
08/20/2003
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 B-1 Voting Common Stock 08/20/2003 M 425(1) A $800 528.47(1) D
Class B-1 Voting Common Stock 12/23/2003 C 20(1) A (8) 548.47(1) D
Common Stock(2) 12/23/2003 S 51,476(2) D $13.09 236,470.75(2) D
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
Stock option (right to buy) $800(3) 08/20/2003 M 425(3) (4) 11/01/2012 Class B-1 Voting Common Stock(3) 425(3) $0 1,275(3) D
Stock option (right to buy) $1,500(5) 09/30/2003 A 137.55(5) (6) 08/13/2013 Class B-1 Voting Common Stock(5) 137.55(5) $0 137.55(5) D
Series A Convertible Preferred Stock (8) 12/23/2003 C 20 (7) (7) Class B-1 Voting Common Stock 20(1) $1,000 0 D
Explanation of Responses:
1. The share information listed for these securities is reported at the time of the reported transaction and does not give effect to a 525-for-1 stock split which occurred after the reported transaction and is described below in Footnote 2.
2. On December 23, 2003, the Company renamed its Class B-1 Voting Common Stock as Common Stock, and the Common Stock split 525-for-1 in the form of a stock dividend of 524 shares for each outstanding share. This stock split resulted in the reporting person's acquisition of 287,398.28 additional shares of Common Stock.
3. The exercise price and share numbers for this security are reported as of the date on which the reported transaction occurred. As described in Footnote 2, on December 23, 2003, the Company renamed its Class B-1 Voting Common Stock as Common Stock, and the Common Stock split 525-for-1. These options contain antidilution provisions. As of the date of this filing, the reporting person beneficially owns options to purchase 669,375 shares of Common Stock at an exercise price of $1.52 per share.
4. These options vest and become exercisable in a series of installments. The first installment, which consisted of 25% of the original aggregate number of options granted, vested on July 28, 2003. The remaining options will become exercisable in a series of twelve successive equal quarterly installments, with the first remaining installment to become exercisable on February 1, 2004.
5. The exercise price and share numbers for this security are reported as of the date on which the reported transaction occurred. As described in Footnote 2, on December 23, 2003, the Company renamed its Class B-1 Voting Common Stock as Common Stock, and the Common Stock split 525-for-1. These options contain antidilution provisions. As of the date of this filing, the reporting person beneficially owns options to purchase 72,213.75 shares of Common Stock at an exercise price of $2.86 per share.
6. These options vest and become exercisable in a series of installments. 25% of the outstanding options will become exercisable on August 13, 2004. The remaining options will become exercisable in a series of twelve successive equal quarterly installments.
7. These securities are Series A Convertible Preferred Stock of the Issuer. As such, they are convertible at any time and do not have an expiration date.
8. 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.
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