SEC Form 4 · accession 0001287151-16-000217
XERIUM TECHNOLOGIES INC · XRM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Harold C Bevis
Officer — President & CEO · Director
Period of report
Aug 15, 2016
Accepted (ET)
Aug 17, 2016 · 4:25 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001287151
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Aug 15, 2016 | M | 260,621 | $4.00 | A | 1,236,363 | D | |
| Common StockF2 | Aug 15, 2016 | F | 192,515 | $8.01 | D | 1,043,848 | D | |
| Common StockF3 | Aug 15, 2016 | F | 32,544 | $8.01 | D | 1,011,304 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Common Stock Options (right to buy) | $4.00 | Aug 15, 2016 | M | 260,621 | D | Aug 15, 2016 | Aug 15, 2022 | Common Stock | 260,621 | 0 | D |
Explanation of responses
- F1Represents gross number of shares underlying the Employee Common Stock Options exercised.
- F2Represents shares withheld in satisfaction of the $4.00 Employee Common Stock Option exercise price and the tax withholding in connection with the issuance of shares of common stock underlying the Employee Common Stock Option.
- F3Represents shares withheld in satisfaction of the tax withholding in connection with the issuance of shares of common stock underlying outstanding Restricted Stock Units.
Remarks
This Form 4 is filed by the Reporting Person to report (i) the exercise of 260,621 employee common stock options that vested on August 15, 2016, (ii) the exercise price and tax withholding in connection with such exercise, and (iii) the tax withholding in connection with the vesting of 68,083 RSUs that vested on August 15, 2016.