Statement of Changes in Beneficial Ownership (4)
October 10 2017 - 2:30PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
HELEN SUZANNE L
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2. Issuer Name
and
Ticker or Trading Symbol
MOHAWK INDUSTRIES INC
[
MHK
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
_____ Officer (give title below)
__
X
__ Other (specify below)
Possible member of group
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(Last)
(First)
(Middle)
C/O MOHAWK INDUSTRIES INC, 2001 ANTIOCH ROAD
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3. Date of Earliest Transaction
(MM/DD/YYYY)
6/16/2017
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(Street)
DALTON, GA 30721
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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6/16/2017
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J
(1)
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V
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420935
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D
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(1)
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0
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I
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SLH Partners LP
(1)
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Common Stock
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141646
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I
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By Family Ltd Ptrshp
(2)
(3)
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Common Stock
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103700
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I
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By SLH Fund LP
(4)
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Common Stock
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201377
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I
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PAS Trust
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(1)
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For estate planning purposes, Reporting Person transferred for no consideration her pecuniary interest in the 420,935 shares held by the SLH Partners LP to other legal entities for the benefit of her children and her descendants. Reporting Person no longer has a pecuniary interest in SLH Partners LP; therefore, the Reporting Person no longer has a beneficial interest in those shares for Section 16 purposes.
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(2)
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Reporting Person may be considered a member of a "group" with certain family members and entities formed for the benefit of certain family members; however, Reporting Person disclaims the existence of such a "group" and disclaims beneficial ownership of any shares not reported herein and any shares in which she has no pecuniary interest.
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(3)
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Reporting Person is one of three family members who share equal control over the general partner of this limited partnership. Reporting Person disclaims beneficial ownership in the number of shares held by the limited partnership to the extent that she does not have a pecuniary interest.
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(4)
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Since the last Form 4 filing, Reporting Person transferred 103,700 shares held directly to SLH Fund LP in exchange for a limited partnership interest. Since Reporting Person retained investment power and voting power over the shares held by SLH Fund LP and retains the pecuniary interest in those shares, the transaction was treated as a change in the form of beneficial ownership and was exempt from reporting and matching pursuant to Rule 16a-13.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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HELEN SUZANNE L
C/O MOHAWK INDUSTRIES INC
2001 ANTIOCH ROAD
DALTON, GA 30721
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Possible member of group
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Signatures
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/s/ Suzanne Helen
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10/10/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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