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
 
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Klocke Tina

(Last) (First) (Middle)
C/O BUILD-A-BEAR WORKSHOP, INC.
1954 INNERBELT BUSINESS CENTRE DRIVE

(Street)
ST. LOUIS MO 63114

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/27/2004
3. Issuer Name and Ticker or Trading Symbol
BUILD A BEAR WORKSHOP INC [ BBW ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
CFBear, Treasurer & Secy
5. If Amendment, Date of Original Filed (Month/Day/Year)
10/29/2004
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 Stock 20,491 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
Employee Stock Option (right to buy) 04/03/2000 04/03/2010 Common Stock 100,000 0.465 D
Employee Stock Option (right to buy) 02/28/2001(1) 02/28/2011 Common Stock 23,000 6.04 D
Employee Stock Option (right to buy) 09/13/2001(1) 09/13/2011 Common Stock 15,000 6.1 D
Employee Stock Option (right to buy) 04/24/2004(2) 04/24/2013 Common Stock 25,000 9.1 D
Employee Stock Option (right to buy) 03/16/2005(2) 03/16/2014 Common Stock 25,000 8.78 D
Series D-1 Convertible Preferred Stock (3) (3) Common Stock 3,870 (4) I Clark/Fox II, L.L.C.
Series D-2 Convertible Preferred Stock (3) (3) Common Stock 10,783 (5) I Clark/Fox II, L.L.C.
Explanation of Responses:
1. The options vest 20% each year beginning on the date specified. All options will automatically vest upon the consummation of the Company's initial public offering.
2. The options vest 25% each year beginning on the date specified. All options will automatically vest upon the consummation of the Company's initial public offering.
3. Convertible upon demand. All shares of preferred stock will convert automatically upon consummation of the Company's initial public offering.
4. 1.200083-to-1.
5. 1.188825-to-1.
/s/ Tina Klocke 11/01/2004
** 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.
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.