-----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, NXpRYdWA18JoRifYV3hARK1fyVvxlwPKQ4S8+eWo3BMsUZ+wv2Fcyu72PMDD3D9m zehM8jBpntltgm+yv/NULA== 0001209191-05-023820.txt : 20050504 0001209191-05-023820.hdr.sgml : 20050504 20050504155134 ACCESSION NUMBER: 0001209191-05-023820 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050502 FILED AS OF DATE: 20050504 DATE AS OF CHANGE: 20050504 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: INVACARE CORP CENTRAL INDEX KEY: 0000742112 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 952680965 STATE OF INCORPORATION: OH FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: ONE INVACARE WAY STREET 2: P O BOX 4028 CITY: ELYRIA STATE: OH ZIP: 44036 BUSINESS PHONE: 4403296000 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MIXON AARON MALACHI III CENTRAL INDEX KEY: 0000937770 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15103 FILM NUMBER: 05799110 BUSINESS ADDRESS: STREET 1: 899 CLEVELAND STREET STREET 2: PO BOX 4028 CITY: ELYRIA STATE: OH ZIP: 44036 BUSINESS PHONE: 2166228207 MAIL ADDRESS: STREET 1: 800 SUPERIOR AVENUE STREET 2: SUITE 1800 CITY: CLEVELAND STATE: OH ZIP: 44107 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2005-05-02 0 0000742112 INVACARE CORP IVC 0000937770 MIXON AARON MALACHI III ONE INVACARE WAY ELYRIA OH 44035 1 1 0 0 Chairman and CEO Common Shares 2005-05-02 4 F 0 5165 41.63 D 514357 D Common Shares 111319 I By GRAT Common Shares 222830 I By Spouse Common Shares 111319 I By GRAT Common Shares 24576 I By GRAT Common Shares 24577 I By GRAT Common Shares 17578 I By Limited Partnership Common Shares 18073 I By Invacare Retirement Savings Plan Class B Common Shares 703912 D Stock Option (Right to Buy) Common Shares 1561850 1561850 D The surrender of these shares is for tax withholding purposes in conjunction with the vesting of restricted shares held by the reporting person. Owned by the Trustee for the 2003 Grantor Retained Annuity Trust created by the reporting person. 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 other purpose. Owned by the Trustee for the 2003 Grantor Retained Annuity Trust created by the reporting person's spouse. Owned by the Trustee for the 1997 Grantor Retained Annuity Trust created by the reporting person's spouse. Owned by the Trustee for the 1997 Grantor Retained Annuity Trust created by the reporting person. Owned by Roundwood Capital, L.P., a limited partnership of which the General Partner is Roundcap LLC, a limited liability company. The reporting person is one of two Managers and Members of Roundcap LLC and, as such, shares investment and voting power with the other Manager and Member and participates equally with them in a 15% carried interest in all profits of the partnership. The reporting person is also the owner of a 10.98% limited partnership interest in Roundwood Capital, L.P. The reporting person disclaims beneficial ownership of the shares owned by the limited partnership provided by Rule 16b-3. Owned by Trustee for the Invacare Retirement Savings Plan. The information given is based on a Plan Statement of December 31, 2004, the most recent information reasonably available. No transaction is being reported on this line. Reported on a previously filed Form 3, Form 4, or Form 5. The reporting person holds previously reported options to buy 1,561,850 Common Shares (with tandem tax withholding rights) under the Invacare Corporation 1994 Performance Plan and the Invacare Corporation 2003 Performance Plan, granted in reliance upon the exemption provided by Rule 16b-3. All options were granted between February 26, 1996 and August 24, 2004, at exercise prices between $18.6875 to $44.30 per share, will expire between February 26, 2006 and August 24, 2014 and became or will become exercisable between March 31, 1997 and September 30, 2008. /s/ A. Malachi Mixon, by Douglas A. Neary, his attorney-in-fact, pursuant to Power of Attorney, dated August 24, 2004, on file with the Commission. 2005-05-04 -----END PRIVACY-ENHANCED MESSAGE-----