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*
GOLSEN SYLVIA H

(Last) (First) (Middle)
16 SOUTH PENNSYLVANIA AVENUE

(Street)
OKLAHOMA CITY OK 73107

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
LSB INDUSTRIES INC [ LXU ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
12/29/2004
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
Common Stock 12/29/2004 G V 553,832 D $0 0 D
Common Stock 12/29/2004 G V 553,832 A $0 838,747 I By Trust(1)
Common Stock 12/29/2004 G V 2,600 D $0 144,929(3)(4) I By Spouse
Common Stock 1,394,299 I By SBL(2)
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
Explanation of Responses:
1. The Sylvia H. Golsen 1992 Revocable Trust, of which Sylvia H. Golsen is Trustee.
2. SBL Corporation ("SBL" is wholly owned by Sylvia H. Golsen (40% owner), Barry Golsen (son and 20% owner), Steven Golsen (son and 20% owner), and Linda Rappaport (daughter and 20% owner). The number of shares beneficially owned by SBL includes 88,100 shares owned of record by Golsen Petroleum Corporation, the wholly owned subsidiary of SBL.
3. The amount shown consists of the following shares beneficially owned by Sylvia H. Golsen's spouse, Jack E. Golsen: (a) 25,000 shares owned of record by Mr. Golsen, and (b) 119,929 held by Mr. Golsen's revocable trust, of which Mr. Golsen is trustee. The amount shown reflects the Form 4, filed December 30, 2004 (the "Amended Form 4"), to amend Mr. Golsen's Form 4 filed September 3, 2004. The Amended Form 4 correctly reports the sale of 35,000 shares by the Jack E. Golsen 1992 Revocable Trust, which shares were previously reported incorrectly as being sold by Mr. Golsen, individually. In addition, the amount shown reflects 85,900 shares that were transferred without consideration from Jack Golsen, individually, to Mr. Golsen's revocable trust.
4. The total amount shown does not include the following derivative securities beneficially owned by Jack E. Golsen: (a) 4,000 shares issuable upon the conversion of a promissory note, (b) 176,500 shares underlying stock options granted to Mr. Golsen, and (c) 133,333 shares issuable upon conversion of 4,000 shares of Series B Preferred Stock. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.
Sylvia H. Golsen 12/30/2004
** 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 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.