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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT 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 1474 (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 Following Reported Transaction(s) (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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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MIXON AARON MALACHI III ONE INVACARE WAY ELYRIA, OH 44035 |
X | Chairman and CEO |
/s/ A. Malachi Mixon III, by Kristofer Spreen, his attorney-in-fact, pursuant to Power of Attorney, dated August 24, 2004, on file with the Commission. | 06/16/2005 | |
**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) | The surrender of these shares is for tax witholding purposes in conjunction with the vesting of restricted shares held by the reporting person. |
(2) | No transaction is being reported on this line. Reported on a previously filed Form 4. Due to an inadvertent clerical error, the number of shares previously reported as directly held by the reporting person in Column 5 of Table I of a Form 4 filed by the reporting person on March 25, 2005 was incorrectly stated and was corrected by an amendment to that Form 4, which was filed on June 9, 2005. This amended Form 4 is being filed solely to amend Column 5 of Table I of the Form 4 filed by the reporting person on May 4, 2005 to report the correct number of shares directly held by the reporting person, as updated to reflect the correction contained on the amended Form 4 filed on June 9, 2005. |