-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Qf+GPfmgTpNdfm0NbEnXQ2fEJra6vTt5ISZt0AUTHFqsgRMFtur4kSp0NSgheiSZ K2yYliVnHP+SGg2k4P90hA== 0000950152-97-008874.txt : 19971230 0000950152-97-008874.hdr.sgml : 19971230 ACCESSION NUMBER: 0000950152-97-008874 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19971217 FILED AS OF DATE: 19971229 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SUBURBAN OSTOMY SUPPLY CO INC CENTRAL INDEX KEY: 0001016872 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-MEDICAL, DENTAL & HOSPITAL EQUIPMENT & SUPPLIES [5047] IRS NUMBER: 042675674 STATE OF INCORPORATION: MA FISCAL YEAR END: 0831 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-28850 FILM NUMBER: 97745528 BUSINESS ADDRESS: STREET 1: 75 OCTOBER HILL RD CITY: HOLLISTON STATE: MA ZIP: 01746 BUSINESS PHONE: 5084291000 MAIL ADDRESS: STREET 1: 75 OCTONBER HILL RD CITY: HOLLISTON STATE: MA ZIP: 01746 COMPANY DATA: COMPANY CONFORMED NAME: INVACARE CORP CENTRAL INDEX KEY: 0000742112 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] OWNER IRS NUMBER: 952680965 STATE OF INCORPORATION: OH FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 899 CLEVELAND ST STREET 2: P O BOX 4028 CITY: ELYRIA STATE: OH ZIP: 44036 BUSINESS PHONE: 2163296000 3 1 INVACARE/SUBURBAN OSTOMY SUPPLY CO. FORM 3 1 --------------------------- OMB APPROVAL --------------------------- - -------- OMB Number: 3235-0104 FORM 3 Expires: April 30, 1997 - -------- Estimated average burden hours per response .... 0.5 --------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 INITIAL STATEMENT OF 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(f) of the Investment Company Act of 1940 - --------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date Invacare Corporation Statement Trading Symbol of Original - --------------------------------------- (Month/Day/Year) Suburban Ostomy Supply Co., Inc. (Month/Day/Year) (Last) (First) (Middle) 12/17/97 (SOSC) ------------------------------------ One Invacare Way ---------------------------- 5. Relationship of Reporting 7. Individual or Joint/ - --------------------------------------- 3. IRS or Social Security Person to Issuer Group Filing (Street) Number of Reporting (Check all applicable) (Check all applicable) Person (Voluntary) X ----- Director ----- 10% Owner Form filed by One Elyria Ohio 44036 ----- Officer ----- Other --- Reporting Person - ------------------------------------- ---------------------------- (give title below) (specify X Form filed by (City) (State) (Zip) below) --- More than One --------------------------- Reporting Person - --------------------------------------------------------------------------------------------------------------------------------- TABLE I-- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - --------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 4) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------- No securities owned (1) - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- *If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses) SEC 1473 (3/91)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership Expiration Date Derivative Security Exercise Form of (Instr. 5) (Month/Day/ (Instr. 4) Price of Deriv- Year) Deri- ative vative Security: Security Direct ------------------------------------------------- (D) or Date Expira- Amount or Indirect (I) Exercis- tion Title Number (Instr. 5) able Date of Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) Pursuant to an Agreement and Plan of Merger dated as of December 17, 1997, by and among the reporting persons and Suburban Ostomy Supply Co., Inc. (the "Company") the reporting persons entered into a Stockholders Agreement with certain stockholders of the Company dated December 17, 1997 whereby Invacare Corporation and certain officers of Invacare Corporation were granted a limited proxy with respect to approximately 45% of the shares of the Company and such stockholders agreed to tender their shares of common stock of the Company in the tender offer commenced by the reporting persons on December 22, 1997. Reference is made to the Schedule 13D filed by the reporting persons on December 22, 1997. The reporting persons have no pecuniary interest in the shares subject to the Stockholders Agreement. /s/ Thomas R. Miklich **Intentional misstatements or omissions of facts constitute Criminal Federal ------------------------------- ------------- Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date Thomas R. Miklich, 12/23/97 Chief Financial Officer Note: File three copies of this form, one of which must be manually signed. Page 2 If space provided is insufficient, See Instruction 6 for procedure. (Print or Type Response)
3 Name: Inva Acquisition Corp. Address: One Invacare Way Elyria, Ohio 44036 Designated Filer: Invacare Corporation Issuer & Ticker Symbol: Suburban Ostomy Supply Co., Inc. Date of Event Requiring Statement: 12/17/97 Signature: /s/ Thomas R. Miklich ------------------------------------- Thomas R. Miklich, Treasurer -----END PRIVACY-ENHANCED MESSAGE-----