0001209191-12-009073.txt : 20120210
0001209191-12-009073.hdr.sgml : 20120210
20120210163644
ACCESSION NUMBER: 0001209191-12-009073
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20111231
FILED AS OF DATE: 20120210
DATE AS OF CHANGE: 20120210
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: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-15103
FILM NUMBER: 12593466
MAIL ADDRESS:
STREET 1: 800 SUPERIOR AVENUE
STREET 2: SUITE 1800
CITY: CLEVELAND
STATE: OH
ZIP: 44107
5
1
doc5.xml
FORM 5 SUBMISSION
X0304
5
2011-12-31
0
0
0
0000742112
INVACARE CORP
IVC
0000937770
MIXON AARON MALACHI III
ONE INVACARE WAY
ELYRIA
OH
44035
1
1
0
0
Chairman
Common Shares
2011-12-02
5
G
0
2900
0.00
D
266363
D
Common Shares
2011-12-02
5
G
0
4800
0.00
D
13669
I
By Spouse
Common Shares
12289
I
By GRAT
Common Shares
12288
I
By GRAT
Common Shares
129970
I
By GRAT
Common Shares
129970
I
By GRAT
Common Shares
18955.58
I
By Invacare Retirement Savings Plan
Class B Common Shares
2011-09-12
5
G
0
247000
0.00
D
456912
D
Class B Common Shares
2011-09-12
5
G
0
123500
0.00
A
123500
I
By GRAT
Class B Common Shares
2011-09-12
5
G
0
123500
0.00
A
123500
I
By Spouse
Class B Common Shares
2011-09-12
5
G
0
123500
0.00
D
0
I
By Spouse
Class B Common Shares
2011-09-12
5
G
0
123500
0.00
A
123500
I
By GRAT
Employee Stock Option (Right to Buy)
Common Shares
1114600
1114600
D
The reporting person disclaims beneficial onwership 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 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 the Trustee for the 2009 Grantor Retained Annuity Trust created by the reporting person.
Owned by the Trustee for the 2009 Grantor Retained Annuity Trust created by the reporting person's spouse.
Owned by the Trustee for the Invacare Retirement Savings Plan. The information given is based on a Plan Statement of December 31, 2011, the most recent information reasonably available.
Owned by the Trustee for the 2011 Grantor Retained Annuity Trust created by the reporting person.
Owned by the Trustee for the 2011 Grantor Retained Annuity Trust created by the reporting person's spouse.
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 1,114,600 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 August 21, 2002 and September 2, 2011, at exercise prices between $20.48 to $44.30 per share, will expire between August 21, 2012 and September 2, 2021 and became or will become exercisable between September 30, 2003 and September 30, 2015.
/s/ A. Malachi Mixon
2012-02-06