|
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 |
|
| |||||||||||||||||||||||||||||
|
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) |
||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Performance-Based Restricted Stock Units | (1) | 08/06/2015 | A | 18,524 | (1) | (1) | Common | 18,524 (1) | $ 0 (1) | 18,524 | D | ||||
Performance-Based Restricted Stock Units | (2) | 05/06/2016 | A | 13,166 | (2) | (2) | Common | 13,166 (2) | $ 0 (2) | 13,166 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
DEROSA THOMAS J 4500 DORR STREET TOLEDO, OH 43615 |
X | Chief Executive Officer |
By: Matthew G. McQueen Attorney-in-Fact For: Thomas J. DeRosa | 10/19/2017 | |
**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 performance-based restricted stock units granted under the Welltower Inc. Amended and Restated 2005 Long-Term Incentive Plan are target shares as defined in the 2015-2017 Long-Term Incentive Program. Final share amounts will be determined at the conclusion of the performance period based on the Company's total shareholder return as determined by the Compensation Committee of the Board of Directors. Each restricted stock unit represents the right to receive one share of HCN's common stock. The original Form 4 filed on August 10, 2015 reported the target shares as 25,478 shares due to a clerical error. |
(2) | The performance-based restricted stock units granted under the Welltower Inc. Amended and Restated 2005 Long-Term Incentive Plan are target shares as defined in the 2016-2018 Long-Term Incentive Program. Final share amounts will be determined at the conclusion of the performance period based on the Company's total shareholder return as determined by the Compensation Committee of the Board of Directors. Each restricted stock unit represents the right to receive one share of HCN's common stock. The original Form 4 filed on May 9, 2016 reported the target shares as 19,691 shares due to a clerical error. |