Amended Annual Statement of Changes in Beneficial Ownership (5/a)
March 26 2018 - 5:26PM
Edgar (US Regulatory)
FORM 5
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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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Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
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1.0
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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
*
KOVACH SUSAN A
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2. Issuer Name
and
Ticker or Trading Symbol
LIBBEY INC [LBY]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
VP,General Counsel & Secretary
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(Last)
(First)
(Middle)
300 MADISON AVENUE, P.O. BOX 10060
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2010
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(Street)
TOLEDO, OH 43699-0060
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
2/15/2018
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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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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Acquired, Disposed of, or 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
(MM/DD/YYYY)
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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 at End of Issuer's Fiscal Year
(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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(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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Phantom Stock Units
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12/15/2009
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A
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154.103
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(2)
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(2)
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Common Stock
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154.103
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$7.10
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154.176
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D
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Phantom Stock Units
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12/31/2009
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A
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143.024
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(2)
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(2)
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Common Stock
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143.024
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$7.65
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297.20
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D
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Phantom Stock Units
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11/30/2010
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A
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79.401
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(2)
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(2)
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Common Stock
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79.401
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$14.47
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376.528
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D
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Phantom Stock Units
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12/15/2010
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A
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80.065
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(2)
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(2)
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Common Stock
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80.065
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$14.35
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456.666
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D
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Phantom Stock Units
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12/31/2010
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A
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74.268
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(2)
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(2)
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Common Stock
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74.268
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$15.47
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530.934
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D
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Phantom Stock Units
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11/15/2011
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A
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94.218
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(2)
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(2)
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Common Stock
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94.218
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$12.53
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625.152
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D
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Phantom Stock Units
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11/30/2011
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A
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97.165
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(2)
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(2)
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Common Stock
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97.165
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$12.15
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722.317
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D
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Phantom Stock Units
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12/15/2011
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A
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95.052
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(2)
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(2)
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Common Stock
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95.052
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$12.42
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817.369
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D
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Phantom Stock Units
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12/31/2011
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A
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92.665
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(2)
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(2)
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Common Stock
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92.665
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$12.74
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997.237
(3)
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D
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Explanation of Responses:
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(1)
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The phantom stock units convert to common stock on a 1-for-1 basis.
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(2)
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Phantom stock units acquired upon deferral of cash compensation under the Libbey executive deferred compensation plan (the "Plan"), a 16b-3 plan. Each phantom stock unit is the economic equivalent of one share of Libbey Inc. common stock. The number of phantom stock units acquired is equivalent to the dollar value of the cash compensation earned based on the market value of Libbey Inc. shares at the time the compensation was earned. The market value of Libbey Inc. shares is the closing price of the Libbey Inc. shares on the New York Stock Exchange on the day the compensation is earned. The units earned are settled in cash at such time as prescribed by the Plan.
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(3)
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Total includes 87.276 phantom stock units acquired during the years 2015 through 2017 under the Plan's dividend-equivalent reinvestment feature.
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Remarks:
This report on Form 5/A amends and replaces in its entirety the Form 5 filed by the Reporting Person on February 14, 2018. This report on Form 5/A is being filed to correct transaction dates, number of derivative securities acquired, and number of derivative securities beneficially owned following reported transactions related to the Reporting Person's deferral of cash compensation under the Plan.
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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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KOVACH SUSAN A
300 MADISON AVENUE
P.O. BOX 10060
TOLEDO, OH 43699-0060
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VP,General Counsel & Secretary
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Signatures
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Debbie Hyndman, Attorney-in-Fact for Susan A. Kovach
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3/26/2018
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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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