FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL [ ] CHECK BOX IF NO LONGER SUBJECT WASHINGTON, D.C. 20549 OMB Number 3235-0362 TO SECTION 16. FORM 4 OR FORM Expires: September 30, 1998 5 OBLIGATIONS MAY CONTINUE. STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden SEE INSTRUCTION 1(B). hours per response . . . . 1.0 [ ] FORM 3 HOLDINGS REPORTED [ ] FORM 4 TRANSACTIONS REPORTED
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(f) of the Investment Company Act of 1940 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading 6. Relationship of Reporting Person to Issuer Symbol WOLVERINE WORLD (Check all applicable) WIDE, INC. ("WWW") BLOOM, GEOFFREY B. [x] Director ____ 10% Owner (Last) (First) (Middle) 3. IRS or Social Security Number of [x] Officer (give ____ Other (specify Reporting Person (Voluntary) title below below 9341 COURTLAND DRIVE, N.E. (Street) CHAIRMAN AND CHIEF EXECUTIVE OFFICER 4. Statement for Month/Year Fiscal 1997 7. Individual or Joint/Group Reporting (check ROCKFORD MICHIGAN 49351 applicable line) (City) (State) (Zip) 5. If Amendment, Date of Original [X] Form Filed by One Reporting Person (Month/Year) __ Form Filed by More than One Reporting February 13, 1998 Person TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
1 of 31. Title of Security 2. Transaction Date 3. Transaction Code 4. Securities Acquired (A) or Disposed of (D) (Instr. 3) (Month/Day/Year) (Instr. 8) (Instr. 3, 4 and 5) Amount (A) or (D) Price 5. Amount of Securities 6. Ownership Form: 7. Nature of Indirect Beneficially Owned Direct (D) or Beneficial Ownership at end of Issuer's Indirect (I) (Instr. 4) Fiscal Year (Instr. 4) (Instr. 3 and 4) * If the form is filed by more than one reporting person, SEE Instruction 4(b)(v). FORM 5 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. Title of Derivative Security 2. Conversion or 3. Transaction 4. Transaction Code 5. Number of Derivative (Instr. 3) Exercise Price Date (Month/ (Instr. 8) Securities Acquired (A) of Derivative Day/Year) or Disposed of (D) Security (Instr. 3, 4 and 5) (A) (D) Stock Option (Right to Buy) $26.4375 9/26/97 A 7,859 Stock Option (Right to Buy) $25.75 11/7/97 G 1,438 Stock Option (Right to Buy) $25.75 11/7/97 G 1,438 Stock Option (Right to Buy) $24.344 11/7/97 G 4,674 Stock Option (Right to Buy) $24.344 11/7/97 G 4,674 Stock Option (Right to Buy) $24.344 11/7/97 G 3,271 Stock Option (Right to Buy) $24.344 11/7/97 G 3,271 1 of 3
6. Date Exercisable and 7. Title and Amount of 8. Price of 9. Number of 10. Ownership 11. Nature of Expiration Date Underlying Securities Derivative Derivative of Deriva- Indirect (Month/Day/Year) (Instr. 3 and 4) Security Securities tive Secur- Beneficial Amount or (Instr. 5) Beneficially ity: Direct Ownership Date Expiration Number of Owned at End (D) or In- (Instr. 4) Exercisable Date Title Shares of Year direct (I) (Instr. 4) (Instr. 4) 9/26/97 4/26/03 Common Stock 7,859 N/A 7,859 D 4/28/97 4/27/07 Common Stock 2,876 N/A 1,438 D 4/28/97 4/27/07 Common Stock 1,438 N/A 1,438 I By Trust 8/12/97 4/26/03 Common Stock 9,348 N/A 4,674 D 8/12/97 4/26/03 Common Stock 4,674 N/A 4,674 I By Trust 8/12/97 2/28/05 Common Stock 6,542 N/A 3,271 D 8/12/97 2/28/05 Common Stock 3,271 N/A 3,271 I By Trust EXPLANATION OF RESPONSES: The number of shares and exercise prices have been adjusted to reflect a 3-for-2 stock split paid to stockholders in May, 1997. /s/Geoffrey B. Bloom 2/17/98 **Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person Date Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Geoffrey B. Blom Note: File three copies of this Form, one of which must be manually signed. By Jeffrey A. Ott If space provided is insufficient, SEE Instruction 6 for procedure. Attorney-in-Fact Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2 FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL [ ] CHECK BOX IF NO LONGER SUBJECT WASHINGTON, D.C. 20549 OMB Number 3235-0362 TO SECTION 16. FORM 4 OR FORM Expires: September 30, 1998 5 OBLIGATIONS MAY CONTINUE. STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden SEE INSTRUCTION 1(B). hours per response . . . . 1.0 [ ] FORM 3 HOLDINGS REPORTED [ ] FORM 4 TRANSACTIONS REPORTED
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(f) of the Investment Company Act of 1940 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading 6. Relationship of Reporting Person to Issuer Symbol WOLVERINE WORLD (Check all applicable) WIDE, INC. ("WWW") BLOOM, GEOFFREY B. [x] Director ____ 10% Owner (Last) (First) (Middle) 3. IRS or Social Security Number of [x] Officer (give ____ Other (specify Reporting Person (Voluntary) title below below 9341 COURTLAND DRIVE, N.E. (Street) CHAIRMAN AND CHIEF EXECUTIVE OFFICER 4. Statement for Month/Year Fiscal 1997 7. Individual or Joint/Group Reporting (check ROCKFORD MICHIGAN 49351 applicable line) (City) (State) (Zip) 5. If Amendment, Date of Original [X] Form Filed by One Reporting Person (Month/Year) __ Form Filed by More than One Reporting February 13, 1998 Person TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
2 of 31. Title of Security 2. Transaction Date 3. Transaction Code 4. Securities Acquired (A) or Disposed of (D) (Instr. 3) (Month/Day/Year) (Instr. 8) (Instr. 3, 4 and 5) Amount (A) or (D) Price 5. Amount of Securities 6. Ownership Form: 7. Nature of Indirect Beneficially Owned Direct (D) or Beneficial Ownership at end of Issuer's Indirect (I) (Instr. 4) Fiscal Year (Instr. 4) (Instr. 3 and 4) * If the form is filed by more than one reporting person, SEE Instruction 4(b)(v). FORM 5 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. Title of Derivative Security 2. Conversion or 3. Transaction 4. Transaction Code 5. Number of Derivative (Instr. 3) Exercise Price Date (Month/ (Instr. 8) Securities Acquired (A) of Derivative Day/Year) or Disposed of (D) Security (Instr. 3, 4 and 5) (A) (D) Stock Option (Right to Buy) $24.344 11/7/97 G 18,071 Stock Option (Right to Buy) $24.344 11/7/97 G 18,071 Stock Option (Right to Buy) $24.344 11/7/97 G 12,428 Stock Option (Right to Buy) $24.344 11/7/97 G 12,428 Stock Option (Right to Buy) $24.344 11/7/97 G 4,078 Stock Option (Right to Buy) $24.344 11/7/97 G 4,078 Stock Option (Right to Buy) $24.344 11/7/97 G 16,166 Stock Option (Right to Buy) $24.344 11/7/97 G 16,166 2 of 3
6. Date Exercisable and 7. Title and Amount of 8. Price of 9. Number of 10. Ownership 11. Nature of Expiration Date Underlying Securities Derivative Derivative of Deriva- Indirect (Month/Day/Year) (Instr. 3 and 4) Security Securities tive Secur- Beneficial Amount or (Instr. 5) Beneficially ity: Direct Ownership Date Expiration Number of Owned at End (D) or In- (Instr. 4) Exercisable Date Title Shares of Year direct (I) (Instr. 4) (Instr. 4) 8/12/97 3/8/05 Common Stock 36,142 N/A 18,071 D 8/12/97 3/8/05 Common Stock 18,071 N/A 18,071 I By Trust 8/12/97 2/27/06 Common Stock 24,856 N/A 12,428 D 8/12/97 2/27/06 Common Stock 12,428 N/A 12,428 I By Trust 8/12/97 3/5/01 Common Stock 8,156 N/A 4,078 D 8/12/97 3/5/01 Common Stock 4,078 N/A 4,078 I By Trust 8/12/97 3/9/04 Common Stock 32,332 N/A 16,166 D 8/12/97 3/9/04 Common Stock 16,166 N/A 16,166 I By Trust EXPLANATION OF RESPONSES: The number of shares and exercise prices have been adjusted to reflect a 3-for-2 stock split paid to stockholders in May, 1997. /s/Geoffrey B. Bloom 2/17/98 **Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person Date Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Geoffrey B. Blom Note: File three copies of this Form, one of which must be manually signed. By Jeffrey A. Ott If space provided is insufficient, SEE Instruction 6 for procedure. Attorney-in-Fact Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2 FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL [ ] CHECK BOX IF NO LONGER SUBJECT WASHINGTON, D.C. 20549 OMB Number 3235-0362 TO SECTION 16. FORM 4 OR FORM Expires: September 30, 1998 5 OBLIGATIONS MAY CONTINUE. STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden SEE INSTRUCTION 1(B). hours per response . . . . 1.0 [ ] FORM 3 HOLDINGS REPORTED [ ] FORM 4 TRANSACTIONS REPORTED
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(f) of the Investment Company Act of 1940 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading 6. Relationship of Reporting Person to Issuer Symbol WOLVERINE WORLD (Check all applicable) WIDE, INC. ("WWW") BLOOM, GEOFFREY B. [x] Director ____ 10% Owner (Last) (First) (Middle) 3. IRS or Social Security Number of [x] Officer (give ____ Other (specify Reporting Person (Voluntary) title below below 9341 COURTLAND DRIVE, N.E. (Street) CHAIRMAN AND CHIEF EXECUTIVE OFFICER 4. Statement for Month/Year Fiscal 1997 7. Individual or Joint/Group Reporting (check ROCKFORD MICHIGAN 49351 applicable line) (City) (State) (Zip) 5. If Amendment, Date of Original [X] Form Filed by One Reporting Person (Month/Year) __ Form Filed by More than One Reporting February 13, 1998 Person TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
3 of 31. Title of Security 2. Transaction Date 3. Transaction Code 4. Securities Acquired (A) or Disposed of (D) (Instr. 3) (Month/Day/Year) (Instr. 8) (Instr. 3, 4 and 5) Amount (A) or (D) Price 5. Amount of Securities 6. Ownership Form: 7. Nature of Indirect Beneficially Owned Direct (D) or Beneficial Ownership at end of Issuer's Indirect (I) (Instr. 4) Fiscal Year (Instr. 4) (Instr. 3 and 4) * If the form is filed by more than one reporting person, SEE Instruction 4(b)(v). FORM 5 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. Title of Derivative Security 2. Conversion or 3. Transaction 4. Transaction Code 5. Number of Derivative (Instr. 3) Exercise Price Date (Month/ (Instr. 8) Securities Acquired (A) of Derivative Day/Year) or Disposed of (D) Security (Instr. 3, 4 and 5) (A) (D) Stock Option (Right to Buy) $23.333 11/7/97 G 5,625 $23.333 11/7/97 G 5,625 $23.333 11/7/97 G 5,625 $23.333 11/7/97 G 3,482 Stock Option (Right to Buy) $23.333 11/7/97 G 5,625 $23.333 11/7/97 G 5,625 $23.333 11/7/97 G 5,625 $23.333 11/7/97 G 3,482 3 of 3
6. Date Exercisable and 7. Title and Amount of 8. Price of 9. Number of 10. Ownership 11. Nature of Expiration Date Underlying Securities Derivative Derivative of Deriva- Indirect (Month/Day/Year) (Instr. 3 and 4) Security Securities tive Secur- Beneficial Amount or (Instr. 5) Beneficially ity: Direct Ownership Date Expiration Number of Owned at End (D) or In- (Instr. 4) Exercisable Date Title Shares of Year direct (I) (Instr. 4) (Instr. 4) 2/24/97 2/23/07 Common Stock 11,250 N/A 5,625 D 2/24/98 2/23/07 Common Stock 11,250 N/A 5,625 D 2/24/99 2/23/07 Common Stock 11,250 N/A 5,625 D 2/24/00 2/23/07 Common Stock 6,965 N/A 3,483 D 2/24/97 2/23/07 Common Stock 5,625 N/A 5,625 I By Trust 2/24/98 2/23/07 Common Stock 5,625 N/A 5,625 I By Trust 2/24/99 2/23/07 Common Stock 5,625 N/A 5,625 I By Trust 2/24/00 2/23/07 Common Stock 3,482 N/A 3,482 I By Trust EXPLANATION OF RESPONSES: The number of shares and exercise prices have been adjusted to reflect a 3-for-2 stock split paid to stockholders in May, 1997. /s/Geoffrey B. Bloom 2/17/98 **Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person Date Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Geoffrey B. Blom Note: File three copies of this Form, one of which must be manually signed. By Jeffrey A. Ott If space provided is insufficient, SEE Instruction 6 for procedure. Attorney-in-Fact Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2 POWER OF ATTORNEY The undersigned, a director and/or officer of Wolverine World Wide, Inc., a Delaware corporation (the "Company"), does hereby nominate, constitute and appoint Blake W. Krueger, George A. Andrews and Jeffrey A. Ott, or any one or more of them, his or her true and lawful attorneys and agents to do any and all acts and things and to execute and file any and all instruments which such attorneys and agents, or any of them, may deem 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 Exchange Act of 1934, as amended (the "Act"), and any requirements of the Securities and Exchange Commission in respect thereof, in connection with the preparation, execution and filing of any report or statement of beneficial ownership or changes in beneficial ownership of securities of the Company 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 Act including, 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 or 5, 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 named herein may rely entirely on information furnished orally or in writing by the undersigned to such attorneys-in-fact. The undersigned also agrees to indemnify and hold harmless the Company 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 to the attorneys-in-fact for purposes of executing, acknowledging, delivering or filing Forms 3, 4 or 5, 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, and agrees to reimburse the Company and the attorneys-in-fact herein 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 the Company 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 the Company and remain in effect thereafter for so long as the undersigned (in his or her individual capacity or in a fiduciary or other capacity) has any obligation under Section 16 of the Act with respect to securities of the Company. Date: 11-9-93 /S/ GEOFFREY B. BLOOM Geoffrey B. Bloom