3: Initial statement of beneficial ownership of securities
Published on May 17, 2011
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIESFiled 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/20/2011 |
3. Issuer Name and Ticker or Trading Symbol
BARRETT BUSINESS SERVICES INC [ BBSI ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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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) |
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Common Stock | 15,000 | D | |
Common Stock | 2,541,832 | I | By Estate of William W. Sherertz(1) |
Common Stock | 19,600 | I | By son |
Common Stock | 20,749 | I | By daughter |
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) | ||
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Nonqualified Stock Options | 01/20/2011 | 01/20/2012 | Common Stock | 2,000 | 11.08 | I | By Estate of William W. Sherertz(1) |
Nonqualified Stock Options | 01/20/2011 | 01/20/2012 | Common Stock | 2,000 | 13.38 | I | By Estate of William W. Sherertz(1) |
Nonqualified Stock Options | 12/30/2005 | 01/20/2012 | Common Stock | 98,697 | 15.2 | I | By Estate of William W. Sherertz(1) |
Explanation of Responses: |
1. These shares are owned directly by the Estate of William W. Sherertz, a ten percent beneficial owner of the issuer, and indirectly by Kimberly J. Sherertz as personal representative of the estate. |
/s/ Kimberly J. Sherertz | 05/13/2011 | |
** 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.
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.