SEC Form 4 · accession 0001209191-15-015541
Polaris Inc. · PII
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael D. Dougherty
Officer — VP-Asia Pac & Latin America
Period of report
Feb 13, 2015
Accepted (ET)
Feb 18, 2015 · 6:20 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000931015
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Feb 2, 2015 | G | 87 | $0.00 | D | 31,043 | I | by spouse's trust |
| Common Stock | holding | — | — | — | 6,000 | D | ||
| Common StockF2 | holding | — | — | — | 4,621 | I | by ESOP | |
| Common StockF3 | holding | — | — | — | 1,630 | I | by wife as UTMA custodian for son | |
| Common StockF4 | holding | — | — | — | 1,630 | I | by wife as UTMA custodian for daughter |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Performance Restricted Stock UnitsF5 | — | Feb 13, 2015 | M | 5,504 | D | — | Mar 15, 2015 | Common Stock | 5,504 | 0 | D |
| Deferred Stock UnitsF6,F7 | — | Feb 13, 2015 | M | 5,504 | A | — | — | Common Stock | 5,504 | 5,504 | D |
Explanation of responses
- F1Shares held in a revocable trust of which the reporting person and his spouse are trustees, and the reporting person and his spouse, or other members of their family, are the beneficiaries.
- F2Estimate of the number of shares held in the reporting person's ESOP fund as of February 13, 2015. This plan uses unit accounting and the number of shares that a participant is deemed to hold varies with the price of Polaris stock.
- F3Shares held by son who shares reporting person's household. The reporting person disclaims beneficial ownership of the shares held by his son, and this report should not be deemed an admission that the reporting person is the beneficial owner of his son's shares for purposes of Section 16 or for any other purpose.
- F4Shares held by daughter who shares reporting person's household. The reporting person disclaims beneficial ownership of the shares held by his daughter, and this report should not be deemed an admission that the reporting person is the beneficial owner of his daughter's shares for purposes of Section 16 or for any other purpose.
- F5Each performance restricted stock unit represents the right to receive, upon vesting, one share of the Issuer's common stock or, if a deferral election is made, one deferred stock unit under the Issuer's Supplemental/Retirement Savings Plan ("SERP").
- F6Each deferred stock unit represents the right to receive one share of the Issuer's common stock, and is received in exchange for one performance restricted stock unit as described in note 5.
- F7At the settlement date elected by the reporting person under the SERP, the reporting person is entitled to receive one share of common stock for each deferred stock unit held. The deferred stock units may be transferred into an alternative investment account in the SERP after a period of six months and one day.