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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 | |
FOSS DONALD A 25505 WEST TWELVE MILE ROAD SOUTHFIELD, MI 48034 |
X | X | Chairman |
/s/ Donald A. Foss | 11/03/2011 | |
**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) | On September 3, 2009, Mr. Foss transferred 2,000,000 shares of Credit Acceptance common stock to a grantor retained annuity trust for the benefit of himself and his minor child as remainderman. On September 6, 2011, 288,027 shares of Credit Acceptance common stock were transferred from such trust to Mr. Foss in satisfaction of such trust's 2011 annuity obligation. |
(2) | Mr. Foss' prior Form 4s for transactions relating to certain grantor retained annuity trusts created by Mr. Foss have reflected shares of Credit Acceptance common stock held by such trusts following such transactions as beneficially owned by Mr. Foss in Column 5 (with an annotations in Columns 6 and 7 reflecting "I" (for indirect ownership) and "by [son/daughter] through grantor retained annuity trust," respectively). Mr. Foss' direct and indirect ownership of Common Stock as reported in Column 5 of this Form 4 has been revised to reflect that Mr. Foss is not the indirect beneficial owner of the shares of Credit Acceptance common stock held by such grantor retained annuity trusts. |
(3) | Shares are owned of record by Karol A. Foss, as Trustee of the Karol A. Foss Revocable Trust Under Agreement dated January 16, 1981, as amended and restated on January 26, 1984, June 28, 1990, December 10, 1997 and April 1, 2005. Pursuant to an agreement dated December 6, 2001, Mr. Foss has sole voting power and dispositive power over such shares but Ms. Foss and her Trusts have the right to receive any dividends on and any proceeds from the sale of such shares. |
(4) | Shares are owned by a limited liability company in which Mr. Foss has a 20% interest. |
(5) | Shares are owned of record by Jill Foss Watson, as Trustee of the Jill Foss Watson Trust Under Agreement dated March 28, 2007 and the Karol A. Foss Irrevocable Grandchildren's Trust dated December 22, 2008. Mr. Foss has sole voting power and dispositive power over such shares but Ms. Foss Watson and her Trusts have the right to receive any dividends on and any proceeds from the sale of such shares. |