- Initial Statement of Beneficial Ownership (3)
March 13 2012 - 2:10PM
Edgar (US Regulatory)
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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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3235-0104
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November 30, 2011
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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
*
Black Stephanie E.
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2. Date of Event Requiring Statement (MM/DD/YYYY)
3/13/2012
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3. Issuer Name
and
Ticker or Trading Symbol
HEADWATERS INC [HW]
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(Last)
(First)
(Middle)
10653 S. RIVERFRONT PARKWAY, SUITE 300
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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)
President HTI Group /
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(Street)
SOUTH JORDAN, UT 84095
(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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6388
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D
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Common Stock ESPP
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16870
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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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Incentive Stock Option
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3/31/2004
(1)
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5/6/2013
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Common Stock
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5000
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$16.89
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D
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Incentive Stock Option
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3/31/2005
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4/21/2014
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Common Stock
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3019
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$23.79
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D
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Non-Qualified Stock Option
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3/31/2003
(2)
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6/10/2012
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Common Stock
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7500
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$13.73
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D
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Non-Qualified Stock Option
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3/31/2005
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4/21/2014
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Common Stock
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2854
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$23.79
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D
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Non-Qualified Stock Option
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3/31/2005
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9/23/2014
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Common Stock
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5000
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$28.31
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D
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Stock Appreciation Rights
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9/30/2012
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9/30/2021
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Common Stock
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41773
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$1.85
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D
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Stock Appreciation Rights
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9/30/2011
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9/30/2020
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Common Stock
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7005
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$3.81
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D
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Stock Appreciation Rights
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9/30/2010
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9/30/2019
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Common Stock
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7914
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$4.6
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D
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Stock Appreciation Rights
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9/30/2009
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9/30/2018
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Common Stock
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7914
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$9.84
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D
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Stock Appreciation Rights
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9/30/2008
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9/30/2017
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Common Stock
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7914
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$13.57
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D
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Explanation of Responses:
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(
1)
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Stock Options Vest pro rata yearly for a period of 3 years on Mar 31st of each vesting year.
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(
2)
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Stock Options vest pro rata yearly for a period of 3 years.
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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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Black Stephanie E.
10653 S. RIVERFRONT PARKWAY, SUITE 300
SOUTH JORDAN, UT 84095
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President HTI Group
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Signatures
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By: Harlan M. Hatfield For: Stephanie E. Black
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3/13/2012
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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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