SEC Form 5 · accession 0001179110-15-006728

ST JUDE MEDICAL, LLC · STJ

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

Reporting owner

Jason Zellers

Officer — VP, General Counsel & Corp Sec

Period of report

Jan 3, 2015

Accepted (ET)

Apr 28, 2015 · 4:33 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0000203077

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2	Dec 14, 2013	M	63	—	A	557	I	By Spouse
Common Stock^F3,F2	Dec 14, 2013	F	22	$57.99	D	535	I	By Spouse
Common Stock^F1,F2	Dec 17, 2013	M	54	—	A	589	I	By Spouse
Common Stock^F4,F2	Dec 17, 2013	F	19	$59.42	D	570	I	By Spouse
Common Stock^F1,F2	Dec 17, 2013	M	63	—	A	633	I	By Spouse
Common Stock^F5,F2	Dec 17, 2013	F	22	$59.42	D	611	I	By Spouse
Common Stock^F1,F2	Dec 14, 2014	M	63	—	A	553	I	By Spouse
Common Stock^F6,F2	Dec 14, 2014	F	22	$66.33	D	531	I	By Spouse
Common Stock^F1,F2	Dec 17, 2014	M	54	—	A	585	I	By Spouse
Common Stock^F7,F2	Dec 17, 2014	F	19	$65.61	D	566	I	By Spouse
Common Stock^F1,F2	Dec 17, 2014	M	63	—	A	629	I	By Spouse
Common Stock^F8,F2	Dec 17, 2014	F	22	$65.61	D	607	I	By Spouse
Common Stock^F1,F2	Dec 17, 2014	M	52	—	A	659	I	By Spouse
Common Stock^F9,F2,F10	Dec 17, 2014	F	18	$65.61	D	641	I	By Spouse
Common Stock	holding	—	—		—	9,091	D

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Restricted Stock Units^F2,F1,F11	—	Dec 14, 2013	M	63	D	Dec 14, 2011	—	Common Stock	126	63	I
Restricted Stock Units^F2,F1,F12	—	Dec 17, 2013	M	54	D	Dec 17, 2012	—	Common Stock	162	108	I
Restricted Stock Units^F2,F1,F12	—	Dec 17, 2013	M	63	D	Dec 17, 2013	—	Common Stock	252	189	I
Restricted Stock Units^F1,F13	—	Dec 14, 2014	M	63	D	Dec 14, 2011	—	Common Stock	63	0	I
Restricted Stock Units^F2,F1,F12	—	Dec 17, 2014	M	54	D	Dec 17, 2012	—	Common Stock	108	54	I
Restricted Stock Units^F2,F1,F12	—	Dec 17, 2014	M	63	D	Dec 17, 2013	—	Common Stock	189	126	I
Restricted Stock Units^F2,F1,F12	—	Dec 17, 2014	M	52	D	Dec 17, 2014	—	Common Stock	208	156	I

Explanation of responses

F1Each restricted stock unit represents a contingent right to receive one share of the Company's common stock.
F10This form 5 is for the 2014 fiscal year end adjusting the totals to reflect an amended form 4 and late reporting of restricted stock vests.
F11The restricted stock units vest 25% on each of the first four anniversary dates of the date of the grant beginning on the date shown.
F12The restricted stock units will vest 25% on December 17th annually beginning the date shown.
F13Fully vested at the time of filing.
F2The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.
F363 shares of restricted stock vested on December 14, 2013. 22 shares were used to pay taxes and 41 shares were released.
F454 shares of restricted stock vested on December 17, 2013. 19 shares were used to pay taxes and 35 shares were released.
F563 shares of restricted stock vested on December 17, 2013. 22 shares were used to pay taxes and 41 shares were released.
F663 shares of restricted stock vested on December 14, 2014. 22 shares were used to pay taxes and 41 shares were released.
F754 shares of restricted stock vested on December 17, 2014. 19 shares were used to pay taxes and 35 shares were released.
F863 shares of restricted stock vested on December 17, 2014. 22 shares were used to pay taxes and 41 shares were released.
F952 shares of restricted stock vested on December 17, 2014. 18 shares were used to pay taxes and 34 shares were released.