- Initial Statement of Beneficial Ownership (3)
15 Ottobre 2008 - 12:28AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Expires:
February 28, 2011
Estimated average burden
hours per response...
0.5
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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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1. Name and Address of Reporting Person
*
Jorgensen David
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2. Date of Event Requiring Statement (MM/DD/YYYY)
10/1/2008
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3. Issuer Name
and
Ticker or Trading Symbol
HAYES LEMMERZ INTERNATIONAL INC [HAYZ]
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(Last)
(First)
(Middle)
15300 CENTENNIAL DRIVE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Corporate Controller /
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(Street)
NORTHVILLE, MI 48168
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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2360
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option (Right to Buy)
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3/16/2005
(2)
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3/16/2014
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Common Stock
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9494
(3)
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$10.61
(1)
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D
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Stock Option (Right to Buy)
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2/1/2008
(4)
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8/10/2017
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Common Stock
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6435
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$3.79
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D
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Stock Option (Right to Buy)
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2/1/2009
(5)
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7/13/2018
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Common Stock
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4624
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$2.45
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D
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Restricted Stock Units
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(6)
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(6)
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Common Stock
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4940
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(6)
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D
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Restricted Stock Units
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(7)
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(7)
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Common Stock
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7148
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(7)
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D
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Explanation of Responses:
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(
1)
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The option price was originally $14.02. On July 17, 2007, the option price was adjusted to $10.35 pursuant to the anti-dilution protection provisions of the issuer's Long Term Incentive Plan.
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(
2)
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The option was to vest in four equal annual installments beginning on March 16, 2005. On January 17, 2006 the issuer's Board of Directors vested all outstanding stock options.
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(
3)
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The number of shares subject to the option was originally 7,051. On July 17, 2007, the number of shares subject to the option was adjusted to 9,494 pursuant to the anti-dilution protection provisions of the Issuer's Long Term Incentive Plan.
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(
4)
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The Stock Options become exercisable in three equal installments on February 1, 2008, February 1, 2009 and February 1, 2010; provided that if the number of shares subject to an option is not evenly divisible by three, the additional share or shares will be included in the first and, if applicable, third installments.
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(
5)
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The Stock Options become exercisable in three equal installments on February 1, 2009, February 1, 2010 and February 1, 2011; provided that if the number of shares subject to an option is not evenly divisible by three, the additional share or shares will be included in the first and, if applicable, third installments.
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(
6)
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Not applicable. The Restricted Stock Units will be converted into 4,940 shares of common stock or the equivalent value in cash on February 1, 2010.
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(
7)
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Not applicable. The Restricted Stock Units will be converted into 7,148 shares of common stock or the equivalent value in cash on February 1, 2011.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Jorgensen David
15300 CENTENNIAL DRIVE
NORTHVILLE, MI 48168
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Corporate Controller
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Signatures
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/s/ Patrick C. Cauley, Attorney in Fact
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10/14/2008
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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