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