SEC 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
|Estimated average burden|
|hours per response:
||Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
1. Name and Address of Reporting Person*
|C/O 9341 COURTLAND DRIVE NE|
2. Issuer Name and Ticker or Trading Symbol
WOLVERINE WORLD WIDE INC /DE/
[ WWW ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
|Sr. VP of Human Resources|
3. Date of Earliest Transaction
4. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||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.
||2. Transaction Date
||2A. Deemed Execution Date, if any
||3. Transaction Code (Instr.
||4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
||6. Ownership Form: Direct (D) or Indirect (I) (Instr.
||7. Nature of Indirect Beneficial Ownership (Instr.
||(A) or (D)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Conversion or Exercise Price of Derivative Security
||3. Transaction Date
||3A. Deemed Execution Date, if any
||4. Transaction Code (Instr.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
||6. Date Exercisable and Expiration Date
||7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
||8. Price of Derivative Security (Instr.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
||10. Ownership Form: Direct (D) or Indirect (I) (Instr.
||11. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
||/s/ David Latchana, by Power of Attorney
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).|
|Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
Instruction 6 for procedure.|
|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 Number.|
LIMITED POWER OF ATTORNEY
The undersigned, a director and/or officer of Wolverine World Wide, Inc., a
Delaware corporation ("Wolverine"), does hereby appoint BRENDAN M. GIBBONS and
DAVID A. LATCHANA, or any one or more of them, with full power of substitution,
his or her attorneys and agents to do any and all acts and things and to execute
and file any and all documents and instruments that such attorneys and agents,
or any of them, consider necessary or advisable to enable the undersigned (in
his or her individual capacity or in a fiduciary or other capacity) to comply
with the Securities Act of 1933, as amended (the "Securities Act"), and the
Securities Exchange Act of 1934, as amended (the "Exchange Act"), and any
requirements of the Securities and Exchange Commission in respect thereof, in
connection with his or her intended sale of any security related to Wolverine
pursuant to Rule 144 issued under the Securities Act and the preparation,
execution and filing of any report or statement of beneficial ownership or
changes in beneficial ownership of securities of Wolverine that the undersigned
(in his or her individual capacity or in a fiduciary or other capacity) may be
required to file pursuant to Section 16(a) of the Exchange
without limitation, full power and authority to sign the undersigned's name, in
his or her individual capacity or in a fiduciary or other capacity, to any
report or statement on Form 3, 4, 5 or 144, or to any amendments or any
successor forms thereto, or any form or forms adopted by the Securities and
Exchange Commission in lieu thereof or in addition thereto, hereby ratifying and
confirming all that such attorneys and agents, or any of them, shall do or cause
to be done by virtue hereof.
The undersigned agrees that the attorneys-in-fact act as legal counsel to
and/or officers of Wolverine in connection with the securities matters addressed
herein, and do not represent the undersigned in his or her personal capacity in
connection with such matters. The undersigned agrees that the attorneys-in-fact
may rely entirely on information furnished orally or in writing by the
undersigned or his or her authorized representative(s) to such
attorneys-in-fact. The undersigned also agrees to indemnify and hold harmless
Wolverine and the attorneys-in-fact against any losses, claims, damages or
liabilities (or actions in respect thereof) that arise out of or are based upon
any untrue statement or omission of necessary fact in the information provided
by the undersigned or his or her authorized representative(s) to the
attorneys-in-fact for purposes of executing, acknowledging, delivering or filing
any such forms, or any amendments or any successor forms thereto, or any form or
forms adopted by the Securities and Exchange Commission in lieu thereof or in
addition thereto. The undersigned agrees to reimburse Wolverine and the
attorneys-in-fact for any legal or other expenses reasonably incurred in
connection with investigating or defending against any such loss, claim, damage,
liability or action.
This authorization shall supersede all prior authorizations to act for the
undersigned with respect to securities of Wolverine in these matters, which
prior authorizations are hereby revoked, and shall survive the termination of
the undersigned's status as a director and/or officer of Wolverine and remain in
effect thereafter for so long as the undersigned (in his or her individual
capacity or in a fiduciary or other capacity) is subject to Rule 144 with
respect to securities of Wolverine or has any obligation under Section 16 of the
Exchange Act with respect to securities of Wolverine.
Date: May 9, 2017
/s/ Amy M. Klimek
Amy M. Klimek