0001209191-13-008418.txt : 20130213 0001209191-13-008418.hdr.sgml : 20130213 20130213163755 ACCESSION NUMBER: 0001209191-13-008418 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121231 FILED AS OF DATE: 20130213 DATE AS OF CHANGE: 20130213 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: 13603799 MAIL ADDRESS: STREET 1: 800 SUPERIOR AVENUE STREET 2: SUITE 1800 CITY: CLEVELAND STATE: OH ZIP: 44107 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2012-12-31 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 2012-11-19 5 G 0 50823 0.00 D 254571 D Common Shares 2012-11-19 5 G 0 34723 0.00 A 83115 I By Spouse Common Shares 2012-11-19 5 G 0 69446 0.00 D 13669 I By Spouse Common Shares 2012-11-19 5 G 0 69446 0.00 A 69446 I By GRAT 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 18900.69 I By Invacare Retirement Savings Plan Class B Common Shares 2012-11-19 5 G 0 551873 0.00 D 2003 D Class B Common Shares 2012-11-19 5 G 0 330907 0.00 A 330907 I By GRAT Class B Common Shares 2012-11-19 5 G 0 220966 0.00 A 261461 I By Spouse Class B Common Shares 2012-11-19 5 G 0 261461 0.00 D 0 I By Spouse Class B Common Shares 2012-11-19 5 G 0 261461 0.00 A 261461 I By GRAT Class B Common Shares 26536 I By GRAT Class B Common Shares 83005 I By GRAT Employee Stock Option (Right to Buy) Common Shares 1042200 1042200 D 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 2012 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 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, 2012, the most recent information reasonably available. Owned by the Trustee for the 2012 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. 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. /s/ A. Malachi Mixon, III 2013-02-13