SEC Form 4 · accession 0000950103-15-007590
Penumbra Inc · PEN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Adam Elsesser
Officer — Chairman, CEO and President · Director
Period of report
Sep 23, 2015
Accepted (ET)
Sep 23, 2015 · 4:14 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001321732
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Sep 23, 2015 | C | 1,000 | — | A | 1,236,838 | D | |
| Common StockF1,F2 | Sep 23, 2015 | C | 13,471 | — | A | 14,144 | I | By Trust |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series B Preferred StockF1 | — | Sep 23, 2015 | C | 1,000 | D | — | — | Common Stock | 1,000 | 0 | D |
| Series B Preferred StockF1,F2 | — | Sep 23, 2015 | C | 13,471 | D | — | — | Common Stock | 13,471 | 0 | I |
Explanation of responses
- F1The Series B Preferred Stock automatically converted into Common Stock on a 1:1 basis upon closing of the Issuer's initial public offering of Common Stock and had no expiration date.
- F2Shares are held by the Siegel/Elsesser Revocable Trust.