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OMB APPROVAL
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- -------- OMB Number: 3235-0104
FORM 3 Expires: April 30, 1997
- -------- Estimated average burden
hours per response .... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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
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<S> <C> <C> <C>
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1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date
Invacare Corporation Statement Trading Symbol of Original
- --------------------------------------- (Month/Day/Year) Suburban Ostomy Supply Co., Inc. (Month/Day/Year)
(Last) (First) (Middle) 12/17/97 (SOSC)
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One Invacare Way ---------------------------- 5. Relationship of Reporting 7. Individual or Joint/
- --------------------------------------- 3. IRS or Social Security Person to Issuer Group Filing
(Street) Number of Reporting (Check all applicable) (Check all applicable)
Person (Voluntary) X
----- Director ----- 10% Owner Form filed by One
Elyria Ohio 44036 ----- Officer ----- Other --- Reporting Person
- ------------------------------------- ---------------------------- (give title below) (specify X Form filed by
(City) (State) (Zip) below) --- More than One
--------------------------- Reporting Person
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TABLE I-- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial
(Instr. 4) Indirect (I) Ownership (Instr. 4)
(Instr. 5)
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No securities owned (1)
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*If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
(Print or Type Responses) SEC 1473 (3/91)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C>
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deri- ative
vative Security:
Security Direct
------------------------------------------------- (D) or
Date Expira- Amount or Indirect (I)
Exercis- tion Title Number (Instr. 5)
able Date of Shares
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Explanation of Responses:
(1) Pursuant to an Agreement and Plan of Merger dated as of December 17, 1997, by and among the reporting persons and Suburban
Ostomy Supply Co., Inc. (the "Company") the reporting persons entered into a Stockholders Agreement with certain stockholders of
the Company dated December 17, 1997 whereby Invacare Corporation and certain officers of Invacare Corporation were granted a limited
proxy with respect to approximately 45% of the shares of the Company and such stockholders agreed to tender their shares of common
stock of the Company in the tender offer commenced by the reporting persons on December 22, 1997. Reference is made to the Schedule
13D filed by the reporting persons on December 22, 1997. The reporting persons have no pecuniary interest in the shares subject to
the Stockholders Agreement.
/s/ Thomas R. Miklich
**Intentional misstatements or omissions of facts constitute Criminal Federal ------------------------------- -------------
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date
Thomas R. Miklich, 12/23/97
Chief Financial Officer
Note: File three copies of this form, one of which must be manually signed. Page 2
If space provided is insufficient, See Instruction 6 for procedure.
(Print or Type Response)
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Name: Inva Acquisition Corp.
Address: One Invacare Way
Elyria, Ohio 44036
Designated Filer: Invacare Corporation
Issuer & Ticker Symbol: Suburban Ostomy Supply Co., Inc.
Date of Event
Requiring Statement: 12/17/97
Signature: /s/ Thomas R. Miklich
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Thomas R. Miklich, Treasurer
