SEC Form 4 · accession 0001209191-15-000143
INVACARE CORP · IVC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Aaron Malachi Mixon III
Director
Period of report
Dec 30, 2014
Accepted (ET)
Jan 2, 2015 · 2:18 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 30, 2014 | F | 7,920 | $16.94 | D | 306,861 | D | |
| Common Shares | Nov 24, 2014 | G | 8,700 | $0.00 | D | 289,161 | D | |
| Common Shares | Nov 28, 2014 | G | 21,300 | $0.00 | D | 276,861 | D | |
| Class B Common Shares | Dec 8, 2014 | G | 63,933 | $0.00 | A | 129,397 | D | |
| Class B Common SharesF5 | Dec 8, 2014 | G | 63,933 | $0.00 | D | 230,049 | I | By GRAT |
| Class B Common SharesF2 | Dec 8, 2014 | G | 63,933 | $0.00 | A | 183,863 | I | By Spouse |
| Class B Common SharesF2,F3 | Dec 8, 2014 | G | 63,933 | $0.00 | D | 160,603 | I | By GRAT |
| Common SharesF2 | holding | — | — | — | 87,141 | I | By Spouse | |
| Common SharesF2,F3 | holding | — | — | — | 69,446 | I | By GRAT | |
| Common SharesF4 | holding | — | — | — | 18,963 | I | By Invacare Retirement Savings Plan |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Option (Right to Buy)F7,F6 | — | holding | — | — | — | — | — | Common Shares | 734,475 | 734,475 | D |
Explanation of responses
- F1The surrender of these shares is for tax withholding purposes in conjunction with the vesting of restricted shares held by the reporting person.
- F2The 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 other purpose.
- F3Owned by Trustee for the 2012 Grantor Retained Annuity Trust created by the reporting person's spouse.
- F4Owned by the Trustee for the Invacare Retirement Savings Plan. The information given is based on a Plan Statement of December 31, 2013, the most recent information reasonably available.
- F5Owned by the Trustee for the 2012 Grantor Retained Annuity Trust created by the reporting person.
- F6No transaction is being reported on this line. Reported on a previously filed Form 3, Form 4, or Form 5.
- F7The reporting person holds previously reported options to buy 734,475 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. All options were granted between September 8, 2005 and March 18, 2013, at exercise prices between $13.37 and $41.87 per share, will expire between September 8, 2015 and March 18, 2023, and became exercisable between September 30, 2006 and March 31, 2014. The current balance represents the termination of 77,825 unvested options on December 30, 2014 pursuant to the terms of the reporting person's retirement agreement with Invacare entered into on November 14, 2014.