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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 2270 (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 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) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Subscription rights to purchase common stock | $ 3.27 (3) | 10/08/2012 | Â | M(1) | Â | 5 | 09/11/2012 | 10/08/2012 | Common Stock | $ 0 | 0 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Powell William A. 5500 TRILLIUM BOULEVARD SUITE 501 HOFFMAN ESTATES, IL 60192 |
 |  |  Senior Vice President and COO |  |
By: /s/ Charles J. Hansen, as Attorney-in-Fact for William A. Powell | 03/17/2014 | |
**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) | Rights issued to Mr. Powell by Sears Holdings Corporation to purchase shares of commons stock on October 8, 2012. |
(2) | Represents one share acquired pursuant to exercise of subscription rights issued to him by Sears Holdings Corporation in October 2012. Due to an administrative error, the one share was previously unreported on Mr. Powell's Form 4 filed on October 16, 2012. |
(3) | The price per whole share of Sears Hometown and Outlet Stores, Inc. common stock was $15.00. Each subscription right entitled the Reporting Person to purchase from Sears Holdings Corporation 0.218091 of a share of SHOS common stock. |