SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES 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
or Section 30(h) of the Investment Company Act of 1940
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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
11/08/2019
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3. Issuer Name and Ticker or Trading Symbol
WINNEBAGO INDUSTRIES INC
[ WGO ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
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VP, WGO, President, Newmar
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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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, $.50 par value |
100 |
I |
By Spouse |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
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: 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 |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
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/s/ Stacy L. Bogart, Vice President, General Counsel and Secretary, Winnebago Industries, Inc. under Power of Attorney |
11/13/2019 |
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** Signature of Reporting Person |
Date |
| 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,
see
Instruction
5
(b)(v). |
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
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,
see
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
BE IT KNOWN, that Matthew L. Miller has made and appointed, and by
these presents does make and appoint, Stacy L. Bogart, acting individually,
in her capacity as compliance officer for Winnebago Industries, Inc., true
and lawful attorney for him and in his name, place and stead, for the
following specific and limited purposes only:
To sign any and all documents required by the
Securities and Exchange Commission to ensure
compliance with the rules and regulations thereof by
me in connection with any transactions I may complete
involving the stock of Winnebago Industries, Inc.
giving and granting said attorney full power and authority to do and perform
all and every act and thing whatsoever necessary to be done in and about the
specific and limited premises set out herein as fully, to all intents and
purposes, as might or could be done if personally present, with full power of
substitution and revocation, hereby ratifying and confirming all that said
attorney shall lawfully do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of
November, 2019.
/s/ Matthew L. Miller
STATE OF INDIANA )
)ss:
COUNTY OF ELKHART )
The foregoing instrument was acknowledged by me this 7th day of
November, 2019, by Matthew L. Miller who is personally known by me and who
did not take an oath.
/s/ Theresa Coppens
Notary Public in and for said State
My Commission Expires: November 18, 2023
