Statement of Changes in Beneficial Ownership (4)
January 05 2023 - 05:04PM
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)
1/4/2023
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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 |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
LTIP Units |
(1) |
1/4/2023 |
|
A |
|
2050 |
|
(1) |
(1) |
Common |
2050 |
(1) |
2050 |
D |
|
Other Stock Units |
(2) |
1/4/2023 |
|
A |
|
2050 |
|
(2) |
(2) |
Common |
2050 |
(2) |
2050 |
D |
|
Explanation of
Responses: |
(1) |
Represents membership
interests in Welltower OP LLC ("Welltower OP"), a subsidiary of
Welltower Inc. (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 LTIP Units were
granted in exchange for the cancelation of certain restricted stock
units previously granted to the reporting person that provided for
time-based vesting (the "Canceled RSUs"). The vesting schedule for
each LTIP Unit is the same as the vesting schedule for the
corresponding Canceled RSU. Upon vesting, the LTIP Units are
convertible at the reporting person's election into vested Class A
Common Units in Welltower OP ("OP Units"). The resulting OP Units
may be exchanged by the reporting person for shares of common
stock, par value $1.00, of the Issuer ("Common Shares") or the
equivalent cash value of Common Shares, as determined by the
Issuer. |
(2) |
Solely in order to reserve
Common Shares to satisfy any exchange in respect of OP Units as
contemplated herein 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. Any Other Stock Units that may be remaining after all OP
Units have been exchanged will be immediately canceled for no
consideration. |
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
|
By: Matthew McQueen, Attorney-In-Fact For:
Kathryn Sullivan |
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1/5/2023 |
**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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