SEC Form 4 · accession 0001262931-17-000002
BAXTER INTERNATIONAL INC · BAX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
John D Forsyth
Director
Period of report
May 2, 2017
Accepted (ET)
May 4, 2017 · 4:51 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000010456
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock, $1 par valueF1 | May 2, 2017 | A | 1,616 | — | A | 28,684 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F2 | $55.68 | May 2, 2017 | A | 9,027 | A | — | May 2, 2027 | Common Stock, $1 par value | 9,027 | 9,027 | D |
Explanation of responses
- F1The reporting person received a grant of 1,616 fully vested shares of common stock of Baxter International Inc. (the "Company"), subject to the terms and conditions of the applicable grant.
- F2The reporting person received a grant of fully vested Company stock options, subject to the terms and conditions of the applicable grant.