SEC Form 5 · accession 0001144204-16-077935
INVACARE CORP · IVC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).
Reporting owner
Period of report
Dec 31, 2015
Accepted (ET)
Jan 29, 2016 · 5:05 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000742112
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common SharesF1 | Dec 18, 2015 | G | 10,000 | — | D | 0 | D | |
| Common SharesF2 | Dec 29, 2015 | G | 1,220 | — | D | 0 | D | |
| Common SharesF3 | Dec 29, 2015 | G | 2,232 | — | D | 154,604 | D | |
| Common SharesF2 | Dec 29, 2015 | G | 2,886 | — | D | 0 | I | By spouse |
| Common SharesF3 | Dec 29, 2015 | G | 109,768 | — | D | 29,651 | I | By spouse |
| Common SharesF4,F5,F7 | holding | — | — | — | 6,000 | I | By GRAT | |
| Common SharesF4,F7 | holding | — | — | — | 8,282 | I | By spouse through Barbara W. Mixon Trust | |
| Common SharesF7 | holding | — | — | — | 108,805 | I | Through A. Malachi Mixon III Trust | |
| Class B Common SharesF7 | holding | — | — | — | 63,446 | D | ||
| Class B Common SharesF6,F7 | holding | — | — | — | 166,603 | I | By GRAT | |
| Class B Common SharesF4,F7 | holding | — | — | — | 183,863 | I | By Spouse | |
| Class B Common SharesF4,F5,F7 | holding | — | — | — | 160,603 | I | By GRAT | |
| Class B Common SharesF7 | holding | — | — | — | 2,003 | I | Through A. Malachi Mixon III Trust | |
| Class B Common SharesF8 | holding | — | — | — | 127,394 | I | By limited partnership |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F7,F9 | — | holding | — | — | — | — | — | Common Shares | 613,675 | 613,675 | D |
Explanation of responses
- F1Mr. Mixon transferred 10,000 Common Shares to family members and friends as bona fide gifts.
- F2This transaction reflects a gift to a family foundation.
- F3This transaction reflects a gift to a non-profit, tax-exempt entity.
- F4The 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 such securities for purposes of Section 16 or for any such person.
- F5Owned by Trustee for the 2012 Grantor Retained Annuity Trust created by the reporting person?s spouse.
- F6Owned by the Trustee for the 2012 Grantor Retained Annuity Trust created by the reporting person.
- F7No transaction is being reported on this line. Reported on a previously filed Form 3, Form 4, or Form 5.
- F8No transaction is being reported. The holding of such shares by reporting person was previously reported. The change in beneficial ownership was exempt under Rule 16a-13.
- F9The reporting person holds previously reported options to buy Common Shares (with tandem tax withholding rights) under the Invacare Corporation 2003 Performance Plan, granted in reliance upon the exemption provided by Rule 16b-3. In connection with the reporting person?s retirement, certain options were forfeited, consistent with the exemption provided by Rule 16a-4 and Rule 16b-3. All options currently outstanding were granted between August 23, 2006, and March 18, 2013, at exercise prices between $13.37 to $25.79 per share, will expire between August 23, 2016, and March 18, 2023, and became exercisable between September 30, 2007, and March 31, 2014.