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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 2270 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Stock Option (Right to Buy) (7) | Â | Â | Â | Â | Â | Â | Â (9) | Â (9) | Common Shares | Â | 613,675 (9) | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MIXON AARON MALACHI III 31100 PINETREE ROAD, #208 PEPPER PIKE, OH 44124 |
 |  |  | Retired as Dir. 6/30/2015 |
/s/ Molly Z. Brown POA for Aaron Malachi Mixon III | 01/29/2016 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Mr. Mixon transferred 10,000 Common Shares to family members and friends as bona fide gifts. |
(2) | This transaction reflects a gift to a family foundation. |
(3) | This transaction reflects a gift to a non-profit, tax-exempt entity. |
(4) | The 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. |
(5) | Owned by Trustee for the 2012 Grantor Retained Annuity Trust created by the reporting person?s spouse. |
(6) | Owned by the Trustee for the 2012 Grantor Retained Annuity Trust created by the reporting person. |
(7) | No transaction is being reported on this line. Reported on a previously filed Form 3, Form 4, or Form 5. |
(8) | No 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. |
(9) | The 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. |