SEC Form 4 · accession 0000950103-15-007591

Penumbra Inc · PEN

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — EVP, Gen. Counsel & Secretary

Period of report

Sep 23, 2015

Accepted (ET)

Sep 23, 2015 · 4:15 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 Stock^F1	Sep 23, 2015	C	1,000	—	A	1,000	D
Common Stock^F1,F2,F3	Sep 23, 2015	C	45,937	—	A	217,233	I	By Trust
Common Stock^F1,F2,F3	Sep 23, 2015	C	47,022	—	A	264,255	I	By Trust
Common Stock^F1,F2,F3	Sep 23, 2015	C	27,041	—	A	291,296	I	By Trust

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Stock Option (right to buy)^F4	$22.04	Aug 12, 2015	A	50,000	A	—	Aug 11, 2025	Common Stock	50,000	50,000	D
Series B Preferred Stock^F1	—	Sep 23, 2015	C	1,000	D	—	—	Common Stock	1,000	0	D
Series B Preferred Stock^F1,F3	—	Sep 23, 2015	C	45,937	D	—	—	Common Stock	45,937	0	I
Series C Preferred Stock^F1,F3	—	Sep 23, 2015	C	47,022	D	—	—	Common Stock	47,022	0	I
Series D Preferred Stock^F1,F3	—	Sep 23, 2015	C	27,041	D	—	—	Common Stock	27,041	0	I

F1The Series B, Series C and Series D 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.
F2A portion of these shares is subject to vesting.
F3Shares are held by The 2010 Robert D. Evans and Norma J. Evans Revocable Trust u/d/t dated November 11, 2010.
F4The option was granted prior to the date on which the Reporting Person became subject to Section 16. The original option grant vests over four years, with 25% of the shares vesting on August 1, 2016 and 1/48 vesting each month thereafter and was previously reported on Form 3.