SEC Form 4 · accession 0001179110-16-033104
ST JUDE MEDICAL, LLC · STJ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Carlson
Officer — Chief Medical Off-VP,Clinical
Period of report
Dec 14, 2016
Accepted (ET)
Dec 16, 2016 · 4:21 pm EST
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 | Dec 14, 2016 | M | 14,200 | $30.58 | A | 22,654 | D | |
| Common StockF1 | Dec 14, 2016 | F | 8,735 | $79.76 | D | 13,919 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Options (Right to Buy)F2 | $30.58 | Dec 14, 2016 | M | 14,200 | D | Dec 15, 2009 | Dec 15, 2016 | Common Stock | 14,200 | 0 | D |
Explanation of responses
- F1Shares of common stock withheld to pay the exercise price of the stock options and to pay tax withholdings. The 14,200 shares acquired upon the option exercise, net of 8,735 shares used to pay exercise price and taxes, resulted in 5,465 shares that were retained.
- F2Fully vested at the time of filing.