0000925177-18-000001.txt : 20180522 0000925177-18-000001.hdr.sgml : 20180522 20180522135914 ACCESSION NUMBER: 0000925177-18-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180507 FILED AS OF DATE: 20180522 DATE AS OF CHANGE: 20180522 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LORBERBAUM JEFFREY S CENTRAL INDEX KEY: 0000925177 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13697 FILM NUMBER: 18852029 MAIL ADDRESS: STREET 1: MOHAWK INDUSTRIES INC STREET 2: P O BOX 12069 CITY: CALHOUN STATE: GA ZIP: 30703 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MOHAWK INDUSTRIES INC CENTRAL INDEX KEY: 0000851968 STANDARD INDUSTRIAL CLASSIFICATION: CARPETS AND RUGS [2273] IRS NUMBER: 521604305 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 160 S INDUSTRIAL BLVD STREET 2: PO BOX 12069 CITY: CALHOUN STATE: GA ZIP: 30701 BUSINESS PHONE: 706-624-2032 MAIL ADDRESS: STREET 1: P O BOX 12069 CITY: CALHOUN STATE: GA ZIP: 30703 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2018-05-07 0 0000851968 MOHAWK INDUSTRIES INC MHK 0000925177 LORBERBAUM JEFFREY S MOHAWK INDUSTRIES INC P O BOX 12069 CALHOUN GA 30703 1 1 1 0 Chairman and CEO Common Stock 8293785 I Aladdin Partners Common Stock 420668 I Dalton Fund Common Stock 439140 I Dalton Partners Common Stock 45187 D Common Stock 315002 I PAS Trust Common Stock 194 I Managed Account Common Stock 2018-05-07 5 G 0 E 420668 A 420668 I See FN 1 Common Stock 2018-05-07 4 J 0 420668 D 420668 I See FN 1 Common Stock 2018-05-07 4 J 0 420668 A 420668 I See FN 1 Common Stock 2018-05-07 4 G 0 420668 D 420668 I See FN 1 Reflects an exchange of the reporting person's 99.8% LP interest in Dalton Fund LP to the Lorberbaum Trust (the "Legacy Trust") for a promissory note from the Legacy Trust and a gift of the reporting person's 0.1% interest in Dalton Fund LP to the Legacy Trust, in each case for estate planning purposes. Beth entities are controlled by the reporting person. Following this transaction, Dalton Fund LP continued to hold 420,668 issuer shares, which are indirectly beneficially owned by the reporting person due to his investment control over such shares. The reporting person disclaims beneficial ownership of the shares held by Dalton Fund LP except to the extent of his individual pecuniary interest in such shares. /s/Christi Scarbro, Attorney-in-Fact for Jeffrey S. Lorberbaum 2018-05-22