0001209191-12-053772.txt : 20121119 0001209191-12-053772.hdr.sgml : 20121119 20121119161604 ACCESSION NUMBER: 0001209191-12-053772 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121115 FILED AS OF DATE: 20121119 DATE AS OF CHANGE: 20121119 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: 121214778 MAIL ADDRESS: STREET 1: 800 SUPERIOR AVENUE STREET 2: SUITE 1800 CITY: CLEVELAND STATE: OH ZIP: 44107 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2012-11-15 0 0000742112 INVACARE CORP IVC 0000937770 MIXON AARON MALACHI III ONE INVACARE WAY ELYRIA OH 44035 1 1 0 0 Chairman Common Shares 2012-11-15 4 F 0 11892 13.02 D 305394 D Common Shares 48392 I By Spouse Common Shares 12289 I By GRAT Common Shares 12288 I By GRAT Common Shares 95247 I By GRAT Common Shares 95247 I By GRAT Common Shares 18955.58 I By Invacare Retirement Savings Plan Class B Common Shares 553876 D Class B Common Shares 26536 I By GRAT Class B Common Shares 40495 I By Spouse Class B Common Shares 83005 I By GRAT Employee Stock Option (Right to Buy) Common Shares 1042200 1042200 D The surrender of these shares is for tax withholding purposes in conjunction with the vesting of restricted shares held 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 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. On September 1, 2012 the grantor retained annuity trust made an annuity distribution of 96,964 Class B Common Shares to the reporting person. Owned by the Trustee for the 2011 Grantor Retained Annuity Trust created by the reporting person. On September 1, 2012 the grantor retained annuity trust made an annuity distribution of 40,495 Class B Common Shares to the reporting person's spouse. 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 1,042,200 Common Shares (with tandem tax withholding rights) under the Invacare Corporation 2003 Performance Plan, granted in reliance upon the exemption provided by Rule 16b-3. All options were granted between August 20, 2003 and August 14, 2012, at exercise prices between $13.37 to $44.30 per share, will expire between August 20, 2013 and August 14, 2022 and became or will become exercisable between September 30, 2004 and September 30, 2016. The current balance reflects the expiration of 122,400 options on August 21, 2012. /s/ A. Malachi Mixon, by Kristofer K. Spreen, his attorney-in-fact pursuant to Power of Attorney, dated February 12, 2009, on file with the Commission. 2012-11-19