SEC Form 4 · accession 0001209191-16-150199
Polaris Inc. · PII
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael D. Dougherty
Officer — President-International
Period of report
Nov 11, 2016
Accepted (ET)
Nov 15, 2016 · 4:38 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 Stock | Apr 29, 2016 | G | 3,704 | $0.00 | D | 5,000 | D | |
| Common StockF1 | Apr 29, 2016 | G | 3,704 | $0.00 | A | 34,378 | I | by spouse's trust |
| Common StockF1 | May 27, 2016 | G | 627 | $0.00 | D | 33,751 | I | by spouse's trust |
| Common StockF2 | May 27, 2016 | G | 305 | $0.00 | A | 2,109 | I | by wife as UTMA custodian for son |
| Common StockF3 | May 27, 2016 | G | 322 | $0.00 | A | 2,147 | I | by wife as UTMA custodian for daughter |
| Common Stock | Nov 11, 2016 | M | 2,000 | $0.00 | A | 7,000 | D | |
| Common Stock | Nov 11, 2016 | S | 2,000 | $89.4592 | D | 5,000 | D | |
| Common StockF4 | holding | — | — | — | 4,705 | I | by ESOP |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Options (Right to Buy)F5 | $38.46 | Nov 11, 2016 | M | 2,000 | D | — | Jan 31, 2021 | Common Stock | 2,000 | 8,000 | 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.
- F2Shares 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.
- F3Shares 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.
- F4Estimate of the number of shares held in the reporting person's ESOP fund as of November 11, 2016. This plan uses unit accounting and the number of shares that a participant is deemed to hold varies with the price of Polaris stock.
- F5The option vested in two equal installments on January 31, 2013 and January 31, 2015.