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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 | |||||||||
Deferred Stock Units | $ 0 | 06/30/2011 | 06/30/2011 | A | 33 (1) | Â | Â (2) | Â (2) | Common Stock | $ 0 | 5,297 (3) | Â | ||
Deferred Stock Units | $ 0 | 09/30/2011 | 09/30/2011 | A | 48 (1) | Â | Â (2) | Â (2) | Common Stock | $ 0 | 5,345 (3) | Â | ||
Deferred Stock Units | $ 0 | 12/30/2011 | 12/30/2011 | A | 36 (1) | Â | Â (2) | Â (2) | Common Stock | $ 0 | 5,381 (3) | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MARCUCCILLI JAMES C 127 WEST BERRY STREET FORT WAYNE, IN 46802 |
 X |  |  |  |
James C. Marcuccilli | 02/15/2011 | |
**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) | Exempt award, pursuant to registrant's 2006 Equity Incentive Plan, of 33 additional Deferred Stock Units (DSUs) on June 30, an additional 48 on September 30 and an additional 36 on December 31, 2011, determined by dividing the dollar amount of deemed dividends on each of the foregoing dates, issued in respect of reporting person's underlying 5,264 DSUs originally awarded June 1, 2011 and previously reported on Form 4 on June 3, 2011, divided by the closing price of Issuer's common stock on the day preceding each dividend record date. |
(2) | The reporting person, by prior election, chose to receive his common stock, when converted from DSUs, at the expiration of one year following the reporting person's termination of service as a director. |
(3) | Totals shown on each line include the same 5,264 originally issued DSUs plus the cumulative additional DSUs issued in respect of the deemed dividend following each dividend date. |