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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 2270 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Stock Option (Right to Buy) | Â | Â | Â | Â | Â | Â | Â (2) | Â (2) | Common Shares | Â | 8,542 (2) | Â | ||
Phantom Stock | Â | Â | Â | Â | Â | Â | Â (3) | Â (3) | Common Shares | Â | 4,334.31 (3) | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Tauscher Ellen O. ONE INVACARE WAY ELYRIA, OH 44036 |
 X |  |  |  |
/s/ Ellen O. Tauscher, by Kristofer K. Spreen, her attorney-in-fact pursuant to Power of Attorney, dated January 23, 2012 on file with the Commission | 02/13/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | No transaction is being reported on this line. Reported on a previously filed Form 3, Form 4, or Form 5. |
(2) | The reporting person holds previously reported options to buy 8,542 Common Shares (with tandem tax withholding rights) under the Invacare Corporation 2003 Performance Plan, granted in reliance upon the exemption provided under Rule 16b-3. The options were granted on February 9, 2012, at an exercise price of $17.56 per share, will expire on February 9, 2022, and became or will become exercisable between March 31, 2013 and March 31, 2016. |
(3) | Represents stock equivalents issued to the reporting person upon deferral of director fees under the 2012 Invacare Corporation Non-Employee Directors Deferred Compensation Plan. Each share of phantom stock is the economic equivalent of one common share of the Issuer. The total amount of phantom stock includes additional accrued dividends in the amount of 69.05 stock equivalents. The phantom stock shall become payable to the reporting person in common shares of the Issuer upon the conclusion of the deferral period on January 1, 2016. |