Annual Statement of Changes in Beneficial Ownership (5)
March 15 2021 - 4:06PM
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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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 WAYNE J | 2. Issuer Name and Ticker or Trading SymbolSHOE CARNIVAL INC [SCVL] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner __X__ Officer (give title below) _____ Other (specify below) CHAIRMAN OF THE BOARD |
(Last)
(First)
(Middle)
7500 E. COLUMBIA STREET | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 1/30/2021 |
(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 | 4/27/2020 | | G | 1285536 (1) | A | $0.0 | 2130954 | D | |
Common Stock | 4/28/2020 | | G | 11636 (2) | A | $0.0 | 2142590 | D | |
Common Stock | 5/13/2020 | | G | 642768 (3) | D | $0.0 | 1499822 | D | |
Common Stock | 9/8/2020 | | G | 106581 (4) | A | $0.0 | 1606403 | D | |
Common Stock | | | | | | | 2499922 | I | by Spouse |
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 642,768 shares of common stock of Shoe Carnival, Inc. (the "Company") that the reporting person received from the J. Wayne Weaver 2018 Grantor Retained Annuity Trust for Leigh Anne Weaver as an annuity payment on April 27, 2020, in accordance with the terms of such trust, and 642,768 shares of common stock of the Company that the reporting person received from the J. Wayne Weaver 2018 Grantor Retained Annuity Trust for Bradley Wayne Weaver (the "Bradley Weaver 2018 GRAT") as an annuity payment on April 27, 2020, in accordance with the terms of such trust. |
(2) | Represents shares of common stock of the Company that the reporting person reacquired from the Bradley Weaver 2018 GRAT on April 28, 2020, in accordance with the terms of such trust. |
(3) | Represents shares of common stock of the Company transferred by the reporting person to the J. Wayne Weaver 2020 Grantor Retained Annuity Trust for Leigh Anne Weaver (the "Leigh Weaver 2020 GRAT") on May 13, 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. The reporting person did not retain any voting or dispositive power over the shares held by the Leigh Weaver 2020 GRAT. |
(4) | Represents shares of common stock of the Company that the reporting person received from the J. Wayne Weaver 2019 Grantor Retained Annuity Trust for Leigh Anne Weaver as an annuity payment on September 8, 2020, in accordance with the terms of such trust. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
WEAVER WAYNE J 7500 E. COLUMBIA STREET EVANSVILLE, IN 47715 | X | X | CHAIRMAN OF THE BOARD |
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Signatures
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By: W. Kerry Jackson For: J. Wayne Weaver | | 3/15/2021 |
**Signature of Reporting Person | Date |
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