SEC Form 4 · accession 0001437749-15-016893

ExamWorks Group, Inc. · EXAM

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

Reporting owner

Kevin J. Kozlowski

Officer — Chief Information Officer

Period of report

Sep 2, 2015

Accepted (ET)

Sep 4, 2015 · 5:11 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001498021

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I
Common Stock	Sep 2, 2015	M	27,276	$2.81	A	60,159	D
Common Stock^F1	Sep 2, 2015	S	13,638	$34.36	D	46,521	D
Common Stock^F2	Sep 2, 2015	S	13,638	$34.36	D	32,883	D
Common Stock	Sep 2, 2015	M	30,847	$3.90	A	63,730	D
Common Stock^F1	Sep 2, 2015	S	15,424	$34.36	D	48,306	D
Common Stock^F2	Sep 2, 2015	S	15,423	$34.36	D	32,883	D
Common Stock	Sep 2, 2015	M	2,591	$4.86	A	35,474	D
Common Stock^F1	Sep 2, 2015	S	1,295	$34.36	D	34,179	D
Common Stock^F2	Sep 2, 2015	S	1,296	$34.36	D	32,883	D
Common Stock	Sep 2, 2015	M	9,286	$9.47	A	42,169	D
Common Stock^F1	Sep 2, 2015	S	4,643	$34.36	D	37,526	D
Common Stock^F2	Sep 2, 2015	S	4,643	$34.36	D	32,883	D

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Employee Stock Option (right to buy)^F3	$2.81	Sep 2, 2015	M	27,276	D	—	Aug 7, 2018	Common Stock	27,276	0	D
Employee Stock Option (right to buy)^F4	$3.90	Sep 2, 2015	M	30,847	D	—	Aug 14, 2019	Common Stock	30,847	0	D
Employee Stock Option (right to buy)^F5	$4.86	Sep 2, 2015	M	2,591	D	—	Feb 15, 2020	Common Stock	2,591	0	D
Employee Stock Option (right to buy)^F6	$9.47	Sep 2, 2015	M	9,286	D	—	Jan 4, 2022	Common Stock	9,286	44,014	D

Explanation of responses

F1The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $33.75 to $34.49, inclusive. The Reporting Person undertakes to provide ExamWorks Group, Inc., any security holder of ExamWorks Group, Inc., or the staff of the U.S. Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote to this Form 4.
F2The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $34.30 to $35.24, inclusive. The Reporting Person undertakes to provide ExamWorks Group, Inc., any security holder of ExamWorks Group, Inc., or the staff of the U.S. Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote to this Form 4.
F3On August 7, 2008, the reporting person was granted an option to purchase 100,231 shares of common stock. The option vested one third on July 14, 2009, one third July 14, 2010 with the remaining one third vesting upon the Registrant's initial public offering on October 28, 2010.
F4On August 14, 2009, the reporting person was granted an option to purchase 30,847 shares of common stock. The option vested one third on July 1, 2010, with the remaining two thirds vesting upon the Registrant's initial public offering on October 28, 2010.
F5On February 15, 2010, the reporting person was granted an option to purchase 2,591 shares of common stock. The option vested in three equal annual installments beginning on February 15, 2011.
F6On January 4, 2012, the reporting person was granted an option to purchase 53,300 shares of common stock. The option vested in three equal annual installments beginning on January 4, 2013.