Statement of Changes in Beneficial Ownership (4)
January 03 2023 - 06:53PM
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 * SULLIVAN KATHRYN
M |
2. Issuer Name and Ticker or Trading
Symbol WELLTOWER INC. [ WELL ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
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(Last)
(First)
(Middle)
4500 DORR STREET |
3. Date of Earliest Transaction (MM/DD/YYYY)
1/3/2023
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(Street)
TOLEDO, OH 43615
(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
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) |
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
1/3/2023 |
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D |
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2050 (1)(2)(3) |
D |
$0.00 |
6598.06 |
D |
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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) |
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 |
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 Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of
Responses: |
(1) |
These restricted stock units
(the "RSUs") in respect of shares of common stock, par value $1.00
per share ("Common Shares"), of Welltower Inc. (the "Issuer") were
previously granted to the reporting person and provided for
time-based vesting. On January 3, 2023, the Issuer canceled the
unvested RSUs upon surrender to the Issuer by the reporting person
(the "Cancelled RSUs"). |
(2) |
In exchange for the
Cancelled RSUs, the reporting person received a replacement award
of membership interests in Welltower OP LLC ("Welltower OP"), a
subsidiary of the Issuer, designated as LTIP Units ("LTIP Units"),
which LTIP Units are intended to qualify as profits interests for
US federal income tax purposes. The vesting schedule for each LTIP
Unit is the same as the vesting schedule for the corresponding
Cancelled RSU. The LTIP Units, if and as they become vested, are
convertible, conditioned upon the satisfaction of minimum
allocations to the capital accounts of the LTIP Units for federal
income tax purposes, into Class A Common Units in Welltower OP ("OP
Units"). The resulting OP Units may be exchanged by the reporting
person for Common Shares or the equivalent cash value of Common
Shares. |
(3) |
(continue from footnote 2)
In order to reserve Common Shares to satisfy any such exchange that
might occur in the future, the reporting person also received an
award of Other Stock Units under the Welltower Inc. 2022 Long-Term
Incentive Plan (the "2022 Plan"). The award of the Other Stock
Units provides the reporting person with the ability to acquire
Common Shares under the 2022 Plan only through the exchange of OP
Units for those shares and in no other manner. Upon the exchange of
OP Units for Common Shares, the reporting person will relinquish
all rights to the exchanged OP Units. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
SULLIVAN KATHRYN M
4500 DORR STREET
TOLEDO, OH 43615 |
X |
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Signatures
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By: Matthew McQueen Attorney-in-Fact For: Kathryn
Sullivan |
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1/3/2023 |
**Signature of Reporting
Person |
Date |
Reminder: Report on a separate line for each class
of securities beneficially owned directly or
indirectly. |
* |
If the form is filed by more than one
reporting person, see Instruction 4(b)(v). |
** |
Intentional misstatements or omissions
of facts constitute Federal Criminal Violations. See 18
U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: |
File three copies of this Form, one of
which must be manually signed. If space is insufficient, see
Instruction 6 for procedure. |
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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