Annual Statement of Changes in Beneficial Ownership (5)
March 13 2020 - 4:02PM
Edgar (US Regulatory)
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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
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0362
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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
*
WEAVER DELORES B | 2. Issuer Name and Ticker or Trading SymbolSHOE CARNIVAL INC [SCVL] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
7500 E. COLUMBIA STREET | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 2/1/2020 |
(Street)
EVANSVILLE, IN 47715
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 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) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Amount | (A) or (D) | Price |
Common Stock | 5/20/2019 | | G | 691192 (1) | A | $0.0 | 1191114 | I | by Spouse |
Common Stock | 8/26/2019 | | G | 345696 (2) | D | $0.0 | 845418 | I | by Spouse |
Common Stock | | | | | | | 2499922 | D | |
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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 (MM/DD/YYYY) | 7. Title and Amount of Securities Underlying Derivative Security (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) |
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | Includes 345,596 shares of common stock of Shoe Carnival, Inc. (the "Company") that the reporting person's spouse received from the J. Wayne Weaver 2018 Grantor Retained Annuity Trust for Leigh Anne Weaver as an annuity payment on May 20, 2019, in accordance with the terms of such trust, and 345,596 shares of common stock of the Company that the reporting person's spouse received from the J. Wayne Weaver 2018 Grantor Retained Annuity Trust for Bradley Wayne Weaver as an annuity payment on May 20, 2019, in accordance with the terms of such trust. |
(2) | On August 26, 2019, the reporting person's spouse transferred 345,696 shares of common stock of the Company to the J. Wayne Weaver 2019 Grantor Retained Annuity Trust for Leigh Anne Weaver (the "Leigh Weaver 2019 GRAT"). Leigh Anne Weaver is the sole trustee of the Leigh Weaver 2019 GRAT and, as sole trustee, has sole voting and dispositive power with respect to the shares held by the Leigh Weaver 2019 GRAT. The reporting person's spouse did not retain any voting or dispositive power over the shares held by the Leigh Weaver 2019 GRAT. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
WEAVER DELORES B 7500 E. COLUMBIA STREET EVANSVILLE, IN 47715 |
| X |
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Signatures
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By: W. Kerry Jackson For: Delores B. Weaver | | 3/13/2020 |
**Signature of Reporting Person | Date |
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