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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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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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*
19300 INTERNATIONAL BOULEVARD SOUTH |
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(Street)
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2. Issuer Name and Ticker or Trading Symbol
ALASKA AIR GROUP INC
[ ALK ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
Staff VP and Controller |
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3. Date of Earliest Transaction
(Month/Day/Year) 12/29/2003
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Employee Stock Option (Rt to Buy) |
$27.94
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12/29/2003 |
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A |
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8,000
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12/29/2004 |
12/29/2013 |
Stock Option |
8,000 |
$27.94
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8,000 |
D |
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Explanation of Responses: |
Remarks: |
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Shannon K. Alberts, Attorney-in-Fact for Brandon Pedersen |
12/30/2003 |
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** 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. |
Limited Power of Attorney
Section 16 Reporting Obligations
I hereby
authorize Alaska Air Group General Counsel and Corporate Secretary Keith
Loveless, Assistant Corporate Secretary Shannon K. Alberts and Assistant
Corporate Secretary Irv Bertram to sign on my behalf all Securities &
Exchange Commission reports in connection with changes of my beneficial
ownership of Alaska Air Group, Inc. securities.
This Power of Attorney
shall remain in full force and effect until revoked by the undersigned in a
signed writing delivered to such attorney-in-fact.
IN WITNESS
WHEREOF, the undersigned has caused this Power of Attorney to be executed
as of this 29th day of December, 2003.
___________________________
Brandon Pedersen
STATE OF
WASHINGTON
COUNTY OF KING
On this 29th day of
December, 2003, Brandon Pedersen personally appeared before me, and
acknowledged that s/he executed the foregoing instrument for the purposes
therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand
and official seal.
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Notary
Public: Lorraine Hurt
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My Commission Expires: 5/9/2007