Amended Statement of Ownership (sc 13g/a)
February 12 2021 - 4:44PM
Edgar (US Regulatory)
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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SCHEDULE 13G
Under the Securities Exchange Act of
1934
(Amendment No. 10)*
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Shoe
Carnival, Inc.
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(Name of
Issuer)
Common Stock, $0.01 par value per share
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(Title of
Class of Securities)
824889109
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(CUSIP Number)
December 31, 2020
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(Date of Event Which
Requires Filing of this Statement)
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Check the appropriate box to designate
the rule pursuant to which this Schedule is filed:
¨
Rule 13d-1(b)
¨
Rule 13d-1(c)
x
Rule 13d-1(d)
*The remainder of this cover page shall
be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for
any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.
The information required in the remainder
of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange
Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all
other provisions of the Act (however, see the Notes).
(continued on the following pages)
1
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NAMES OF REPORTING PERSONS
J. Wayne Weaver
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (See Instructions)
(a) ¨
(b) x
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF ORGANIZATION
United States
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NUMBER OF
SHARES
BENEFICIALLY OWNED BY
EACH REPORTING
PERSON WITH:
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5
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SOLE VOTING POWER
1,606,403 (1)
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6
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SHARED VOTING POWER
2,499,922 (2)
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7
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SOLE DISPOSITIVE POWER
1,606,403 (1)
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8
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SHARED DISPOSITIVE POWER
2,499,922 (2)
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
4,106,325 (1)(2)
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10
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CHECK
IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (See Instructions) ¨
N/A
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
29.1% (1)(2)(3)
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12
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TYPE OF REPORTING PERSON (See Instructions)
IN
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(1)
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Represents the number of shares beneficially owned by Mr. Weaver after his receipt of
642,768 shares from the J. Wayne Weaver 2018 Grantor Retained Annuity Trust for Leigh Anne Weaver (the “Leigh Weaver
2018 GRAT”) as an annuity payment on April 27, 2020, in accordance with the terms of the Leigh Weaver 2018 GRAT,
his receipt of 642,768 shares from the J. Wayne Weaver 2018 Grantor Retained Annuity Trust for Bradley Wayne Weaver (the
“Bradley Weaver GRAT”) as an annuity payment on April 27, 2020, in accordance with the terms of the Bradley
Weaver GRAT, his reacquisition of 11,636 shares from the Bradley Weaver GRAT on April 28, 2020, the transfer of 642,768
shares by Mr. Weaver to the J. Wayne Weaver 2020 Grantor Retained Annuity Trust for Leigh Anne Weaver (the “Leigh
Weaver 2020 GRAT”) on May 13, 2020, and his receipt of 106,581 shares from the J. Wayne Weaver 2019 Grantor
Retained Annuity Trust for Leigh Anne Weaver (the “Leigh Weaver 2019 GRAT”) on September 8, 2020. Leigh Anne
Weaver is the sole trustee of the Leigh Weaver 2020 GRAT and, as sole trustee, has sole voting and dispositive power with
respect to the shares held by the Leigh Weaver 2020 GRAT. Mr. Weaver did not retain any voting or dispositive power over
the shares held by the Leigh Weaver 2020 GRAT.
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(2)
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Includes 2,499,922 shares owned by Mr. Weaver’s
spouse.
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(3)
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Based on 14,103,570 outstanding shares of the Issuer’s
common stock as of December 1, 2020, as reported by the Issuer in its Quarterly Report on Form 10-Q for the period ended
October 31, 2020, filed with the Securities and Exchange Commission on December 4, 2020.
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1
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NAMES OF REPORTING PERSONS
Delores B. Weaver
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (See Instructions)
(a) ¨
(b) x
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF ORGANIZATION
United States
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NUMBER OF
SHARES
BENEFICIALLY OWNED BY
EACH REPORTING
PERSON WITH:
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5
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SOLE VOTING POWER
2,499,922
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6
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SHARED VOTING POWER
1,606,403 (1)
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7
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SOLE DISPOSITIVE POWER
2,499,922
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8
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SHARED DISPOSITIVE POWER
1,606,403 (1)
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
4,106,325 (1)
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10
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CHECK
IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (See Instructions) ¨
N/A
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
29.1% (1)(2)
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12
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TYPE OF REPORTING PERSON (See Instructions)
IN
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(1)
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Includes 1,606,403 shares beneficially owned by Mrs. Weaver’s
spouse after Mr. Weaver’s receipt of 642,768 shares from the Leigh Weaver 2018 GRAT as an annuity payment on April 27,
2020, in accordance with the terms of the Leigh Weaver 2018 GRAT, his receipt of 642,768 shares from the Bradley Weaver GRAT as
an annuity payment on April 27, 2020, in accordance with the terms of the Bradley Weaver GRAT, his reacquisition of 11,636
shares from the Bradley Weaver GRAT on April 28, 2020, the transfer of 642,768 shares by Mr. Weaver to the Leigh Weaver
2020 GRAT on May 13, 2020, and his receipt of 106,581 shares from the Leigh Weaver 2019 GRAT on September 8, 2020. Leigh
Anne Weaver is the sole trustee of the Leigh Weaver 2020 GRAT and,
as sole trustee, has sole voting and dispositive power with respect to the shares held by the Leigh Weaver 2020 GRAT. Mrs. Weaver’s spouse did not retain any voting or dispositive power
over the shares held by the Leigh Weaver 2020 GRAT.
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(2)
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Based on 14,103,570 outstanding shares of the Issuer’s
common stock as of December 1, 2020, as reported by the Issuer in its Quarterly Report on Form 10-Q for the period ended
October 31, 2020, filed with the Securities and Exchange Commission on December 4, 2020.
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Item 1.
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(a)
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Name of Issuer
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Shoe Carnival, Inc. (the “Issuer”)
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(b)
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Address of Issuer’s Principal Executive Offices
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7500 East Columbia Street
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Evansville, Indiana 47715
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Item 2.
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(a)
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Name of Person Filing
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(b)
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Address of Principal Business Office or, if none, Residence
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(i)
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J. Wayne Weaver
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7500 East Columbia Street
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Evansville, Indiana 47715
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(ii)
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Delores B. Weaver
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7500 East Columbia Street
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Evansville, Indiana 47715
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(i)
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J. Wayne Weaver:
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United States
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(ii)
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Delores B. Weaver:
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United States
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(d)
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Title of Class of Securities
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Common Stock, par value $0.01 per share (“Common
Stock”)
824889109
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Item 3.
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If this statement is filed pursuant to §§ 240.13d-1(b) or 240.13d-2(b) or (c), check whether the
person filing is a:
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(a)
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Broker or dealer registered under section 15 of the Act.
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(b)
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Bank as defined in section 3(a)(6) of the Act.
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(c)
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Insurance company as defined in section 3(a)(19) of the Act.
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(d)
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Investment company registered under section 8 of the Investment Company Act of 1940.
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(e)
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An investment adviser in accordance with § 240.13d-1(b)(1)(ii)(E).
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(f)
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An employee benefit plan or endowment fund in accordance with § 240.13d-1(b)(1)(ii)(F).
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(g)
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A parent holding company or control person in accordance with § 240.13d-1(b)(1)(ii)(G).
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(h)
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A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act.
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(i)
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A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company
Act of 1940.
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(j)
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A non-U.S. institution in accordance with § 240.13d-1(b)(1)(ii)(J).
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(k)
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Group, in accordance with § 240.13d-1(b)(1)(ii)(K).
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(a)
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Amount Beneficially Owned
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(i)
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J. Wayne Weaver:
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4,106,325 shares (1)
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(ii)
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Delores B. Weaver:
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4,106,325 shares (2)
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(i)
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J. Wayne Weaver:
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29.1% (1)(3)
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(ii)
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Delores B. Weaver:
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29.1% (2)(3)
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(c)
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Number of shares as to which such person has:
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(i)
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Sole power to vote or to direct the vote
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(i)
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J. Wayne Weaver:
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1,606,403
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(ii)
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Delores B. Weaver:
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2,499,922
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(ii)
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Shared power to vote or to direct the vote
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(i)
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J. Wayne Weaver:
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2,499,922 (1)
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(ii)
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Delores B. Weaver:
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1,606,403 (2)
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(iii)
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Sole power to dispose or to direct the disposition of
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(i)
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J. Wayne Weaver:
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1,606,403
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(ii)
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Delores B. Weaver:
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2,499,922
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(iv)
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Shared power to dispose or to direct the disposition of
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(i)
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J. Wayne Weaver:
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2,499,922 (1)
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(ii)
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Delores B. Weaver:
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1,606,403 (2)
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(1)
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Includes 2,499,922 shares owned by Mr. Weaver’s spouse.
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(2)
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Includes 1,606,403 shares owned by Mrs. Weaver’s
spouse.
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(3)
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The percentage of shares beneficially owned is based on 14,103,570 outstanding shares of the Issuer’s common stock as
of December 1, 2020, as reported by the Issuer in its Quarterly Report on Form 10-Q for the period ended October 31,
2020, filed with the Securities and Exchange Commission on December 4, 2020.
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Item 5.
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Ownership of Five Percent or Less of a Class
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If this statement is being filed to report
the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the
class of securities, check the following ¨.
Not Applicable
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Item 6.
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Ownership of More than Five Percent on Behalf of Another Person.
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Not Applicable
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Item 7.
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Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding
Company or Control Person
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Not Applicable
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Item 8.
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Identification and Classification of Members of the Group
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Not Applicable
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Item 9.
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Notice of Dissolution of Group
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Not Applicable
Not Applicable
SIGNATURE
After reasonable inquiry and to the
best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and
correct.
Date: February 12, 2021
By:
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/s/ J. Wayne Weaver
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J. Wayne Weaver
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By:
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/s/ Delores B. Weaver
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Delores B. Weaver
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