SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
LORBERBAUM JEFFREY S

(Last) (First) (Middle)
MOHAWK INDUSTRIES INC
P O BOX 12069

(Street)
CALHOUN GA 30703

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MOHAWK INDUSTRIES INC [ MHK ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chairman and CEO
3. Date of Earliest Transaction (Month/Day/Year)
05/07/2018
4. If Amendment, Date of Original Filed (Month/Day/Year)
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. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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
Common Stock 8,293,785 I Aladdin Partners
Common Stock 420,668 I Dalton Fund
Common Stock 439,140 I Dalton Partners
Common Stock 45,187 D
Common Stock 315,002 I PAS Trust
Common Stock 194 I Managed Account
Common Stock 05/07/2018 G(1) V 420,668 A (1) 420,668 I See FN 1(1)
Common Stock 05/07/2018 J(1) 420,668 D (1) 420,668 I See FN 1(1)
Common Stock 05/07/2018 J(1) 420,668 A (1) 420,668 I See FN 1(1)
Common Stock 05/07/2018 G(1) 420,668 D (1) 420,668 I See FN 1(1)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 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: 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
Explanation of Responses:
1. Reflects an exchange of the reporting person's 99.8% LP interest in Dalton Fund LP to the Lorberbaum Trust (the "Legacy Trust") for a promissory note from the Legacy Trust and a gift of the reporting person's 0.1% interest in Dalton Fund LP to the Legacy Trust, in each case for estate planning purposes. Beth entities are controlled by the reporting person. Following this transaction, Dalton Fund LP continued to hold 420,668 issuer shares, which are indirectly beneficially owned by the reporting person due to his investment control over such shares. The reporting person disclaims beneficial ownership of the shares held by Dalton Fund LP except to the extent of his individual pecuniary interest in such shares.
/s/Christi Scarbro, Attorney-in-Fact for Jeffrey S. Lorberbaum 05/22/2018
** 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).
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