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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MH Holdings, Inc. 225 W. WASHINGTON ST. INDIANAPOLIS, IN 46204 |
X |
Herbert Simon, 50% Owner of MH Holdings, Inc. by his attorney-in-fact, Shelly J. Doran | 03/02/2010 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Private sale from MH Holdings, Inc. to The Herbert Simon Revocable Trust u/a/d December 19, 2008 (the "Trust"). Herbert Simon is the trustee of the Trust, which is the 50% owner of MH Holdings, Inc. |
(2) | Includes 8,899 common shares received on March 18, 2009, 3,051 common shares received on June 19, 2009, 2,435 common shares received on September 18, 2009 and 2,166 common shares received on December 18, 2009 as dividends. The Company's quarterly dividends in 2009 were paid in a combination of cash and shares of common stock. Although the reporting person owns less than 10%, it may be considered part of a group that beneficially owns more than 10%. Other members of the group have reported the securities reported on this form as indirectly owned by such persons. |