SEC Form 5 · accession 0000899243-19-007029
SHOE STATION GROUP INC · SHOE
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Wayne J Weaver
Officer — CHAIRMAN OF THE BOARD · Director · 10% Owner
Period of report
Feb 2, 2019
Accepted (ET)
Mar 11, 2019 · 4:05 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000895447
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Feb 27, 2018 | G | 1,000,000 | $0.00 | D | 1,499,922 | D | |
| Common StockF3,F2 | Feb 27, 2018 | G | 1,000,000 | $0.00 | D | 499,922 | D | |
| Common StockF2 | holding | — | — | — | 2,499,922 | I | By Spouse |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1On February 27, 2018, the reporting person transferred 1,000,000 shares of common stock of Shoe Carnival, Inc. (the "Company") to the J. Wayne Weaver 2018 Grantor Retained Annuity Trust for Leigh Anne Weaver (the "Leigh Weaver GRAT"). Leigh Anne Weaver is the sole trustee of the Leigh Weaver GRAT and, as sole trustee, has sole voting and dispositive power with respect to the shares held by the Leigh Weaver GRAT. The reporting person did not retain any voting or dispositive power over the shares held by the Leigh Weaver GRAT.
- F2Reflects the three-for-two stock split of the shares of the Company's common stock, which was effected in the form of a stock dividend paid on April 27, 2012 to shareholders of record at the close of business on April 13, 2012. As a result, the reporting person and the reporting person's spouse each received 833,307 shares of the Company's common stock as of April 27, 2012.
- F3On February 27, 2018, the reporting person transferred 1,000,000 shares of the Company's common stock to the J. Wayne Weaver 2018 Grantor Retained Annuity Trust for Bradley Wayne Weaver (the "Bradley Weaver GRAT"). Bradley W. Weaver is the sole trustee of the Bradley Weaver GRAT and, as sole trustee, has sole voting and dispositive power with respect to the shares held by the Bradley Weaver GRAT. The reporting person did not retain any voting or dispositive power over the shares held by the Bradley Weaver GRAT.