-----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, JTjRzFC+9IkrCAEecB/FGlSoHQmbz021KXm9Qxy+AHQmROcqiInaKpQTw6ue6w2u iwud3EtQNoUTjloRChE4ZA== 0001209191-05-046819.txt : 20050912 0001209191-05-046819.hdr.sgml : 20050912 20050912153707 ACCESSION NUMBER: 0001209191-05-046819 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050908 FILED AS OF DATE: 20050912 DATE AS OF CHANGE: 20050912 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: 051079941 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 2005-09-08 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 518095 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 18073 I By Invacare Retirement Savings Plan Common Shares 703912 D Employee Stock Option (Right to Buy) 41.87 2005-09-08 4 A 0 30200 0.00 A 2006-09-30 2015-09-08 Common Shares 30200 1592050 D Employee Stock Option (Right to Buy) 41.87 2005-09-08 4 A 0 30200 0.00 A 2007-09-30 2015-09-08 Common Shares 30200 1622250 D Employee Stock Option (Right to Buy) 41.87 2005-09-08 4 A 0 30200 0.00 A 2008-09-30 2015-09-08 Common Shares 30200 1652450 D Employee Stock Option (Right to Buy) 41.87 2005-09-08 4 A 0 30200 0.00 A 2009-09-30 2015-09-08 Common Shares 30200 1682650 D Includes 2,776 Common Shares received as a liquidating distribution from Roundwood Capital, L.P. In prior reports, the reporting person reported beneficial ownership of 17,578 Common Shares held by Roundwood Capital, L.P. 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 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. The reporting person was granted options to purchase Common Shares (with tandem tax withholding rights) under the Invacare Corporation 2003 Performance Plan in reliance upon an exemption provided under Rule 16b-3. 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. 2005-09-12 -----END PRIVACY-ENHANCED MESSAGE-----