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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1. Name and Address of Reporting Person*
Jorgensen David

(Last) (First) (Middle)
15300 CENTENNIAL DRIVE

(Street)
NORTHVILLE MI 48168

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/01/2008
3. Issuer Name and Ticker or Trading Symbol
HAYES LEMMERZ INTERNATIONAL INC [ HAYZ ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Corporate Controller
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 2,360 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) 03/16/2005(2) 03/16/2014 Common Stock 9,494(3) $10.61(1) D
Stock Option (Right to Buy) 02/01/2008(4) 08/10/2017 Common Stock 6,435 $3.79 D
Stock Option (Right to Buy) 02/01/2009(5) 07/13/2018 Common Stock 4,624 $2.45 D
Restricted Stock Units (6) (6) Common Stock 4,940 (6) D
Restricted Stock Units (7) (7) Common Stock 7,148 (7) D
Explanation of Responses:
1. The option price was originally $14.02. On July 17, 2007, the option price was adjusted to $10.35 pursuant to the anti-dilution protection provisions of the issuer's Long Term Incentive Plan.
2. The option was to vest in four equal annual installments beginning on March 16, 2005. On January 17, 2006 the issuer's Board of Directors vested all outstanding stock options.
3. The number of shares subject to the option was originally 7,051. On July 17, 2007, the number of shares subject to the option was adjusted to 9,494 pursuant to the anti-dilution protection provisions of the Issuer's Long Term Incentive Plan.
4. The Stock Options become exercisable in three equal installments on February 1, 2008, February 1, 2009 and February 1, 2010; provided that if the number of shares subject to an option is not evenly divisible by three, the additional share or shares will be included in the first and, if applicable, third installments.
5. The Stock Options become exercisable in three equal installments on February 1, 2009, February 1, 2010 and February 1, 2011; provided that if the number of shares subject to an option is not evenly divisible by three, the additional share or shares will be included in the first and, if applicable, third installments.
6. Not applicable. The Restricted Stock Units will be converted into 4,940 shares of common stock or the equivalent value in cash on February 1, 2010.
7. Not applicable. The Restricted Stock Units will be converted into 7,148 shares of common stock or the equivalent value in cash on February 1, 2011.
/s/ Patrick C. Cauley, Attorney in Fact 10/14/2008
** 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.
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