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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 | ||||||||
Class B Common Stock | (1) | 11/16/2015 | G(2) | V | 75,383 | (1) | (1) | Class A Common Stock | 75,383 | $ 0 | 2,562,231 (3) | I | By The Sidney B. DeBoer Trust (4) | ||
Class B Common Stock | (1) | 12/22/2015 | J(5) | 20,000 | (1) | (1) | Class A Common Stock | 20,000 | $ 0 | 2,562,231 (3) | I | The Sidney B. DeBoer Trust (4) | |||
Class B Common Stock | (1) | 12/24/2015 | C | 20,000 | (1) | (1) | Class A Common Stock | 20,000 | $ 0 | 2,542,231 (3) | I | By The Sidney B. DeBoer Trust (4) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
DEBOER SIDNEY B 150 N. BARTLETT STREET MEDFORD, OR 97501 |
X | X | Executive Chairman |
Larissa McAlister, Attorney-in-Fact for Sidney B. DeBoer | 12/28/2015 | |
**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) | Class B Common Stock is immediately convertible on a one-for-one basis into Class A Common Stock and has no expiration date. |
(2) | The Sidney B. DeBoer Trust transferred as a gift a portion of the Sidney B. DeBoer Trust's membership interest in DeBoer Family LLC. The Sidney B. DeBoer Trust is a member of DeBoer Family LLC, which is a member of Lithia Holding Company, L.L.C. The reporting person is the settlor of the Sidney B. DeBoer Trust, and the Sidney B. DeBoer Trust is revocable by the reporting person at any time at the reporting person's option. |
(3) | As permitted by instruction 4(b)(iv) to Form 4, the reporting person is reporting beneficial ownership of all of shares of Lithia Motors, Inc. Class B Common Stock owned by Lithia Holding Company, L.L.C. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. |
(4) | The reporting person is the settlor of the Sidney B. DeBoer Trust, and the Sidney B. DeBoer Trust is revocable by the reporting person at any time at the reporting person's option. The Sidney B. DeBoer Trust is a member and the sole manager of Lithia Holding Company, L.L.C. The Sidney B. DeBoer Trust is also a member and the sole manager of DeBoer Family, LLC, and DeBoer Family LLC is a member of Lithia Holding Company, L.L.C. |
(5) | The Sidney B. DeBoer Trust, a member of Lithia Holding Company, L.L.C., received these securities in a distribution from Lithia Holding Company, L.L.C. |