SEC FORM 3 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*
BASSETT JOHN E III

(Last) (First) (Middle)
BASSETT FURNITURE INDUSTRIES INC
3525 FAIRYSTONE PARK HWY

(Street)
BASSETT VA 24055

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/24/2004
3. Issuer Name and Ticker or Trading Symbol
BASSETT FURNITURE INDUSTRIES INC [ BSET ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
vice President Global Sourcing
5. 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 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)
COMMON 17,421 D
COMMON 2,715 I WIFE
COMMON 3,118 I SON JOHN IV
COMMON 3,118 I SON JAMES
COMMON 3,118 I SON HAYDEN
COMMON(1) 301.84 D
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
OPTION(2) 01/01/1995 05/04/2004 COMMON 1,000 26.25 D
OPTION(2) 11/07/1997 05/06/2007 COMMON 2,000 22.625 D
OPTION(3) 11/07/2000 03/23/2008 COMMON 27,628 32.25 D
OPTION(3) 01/18/2001 01/17/2010 COMMON 6,140 14.875 D
OPTION(3) 01/18/2002 01/17/2010 COMMON 6,140 14.875 D
OPTION(3) 01/18/2003 01/17/2010 COMMON 6,140 14.875 D
OPTION(3) 01/15/2003 01/14/2012 COMMON 2,667 14.7 D
OPTION(3) 01/15/2004 01/14/2012 COMMON 2,667 14.7 D
OPTION(3) 01/15/2005 01/14/2012 COMMON 2,666 14.7 D
Explanation of Responses:
1. SHARES ACQUIRED UNDER THE EMPLOYEE STOCK PURCHASE PLAN
2. GRANTED UNDER THE 1993 LONG TERM INCENTIVE PLAN WHICH IS A RULE 16b-3 PLAN.
3. GRANTED UNDER THE 1997 EMPLOYEE STOCK PLAN WHICH IS A RULE 16b-3 PLAN.
John E Bassett III 02/20/2004
** 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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