SEC Form 4 · accession 0001073397-15-000001
ICU MEDICAL INC/DE · ICUI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
George A Lopez
Director · 10% Owner
Period of report
Jan 5, 2015
Accepted (ET)
Jan 5, 2015 · 6:54 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000883984
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Jan 5, 2015 | X | 16,400 | $32.92 | A | 414,435 | D | |
| Common StockF2 | Jan 5, 2015 | S | 16,400 | $80.7519 | D | 398,035 | D | |
| Common Stock | holding | — | — | — | 1,086,843 | I | by Partnership |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Incentive Stock Option (right to buy)F3 | $32.92 | Jan 5, 2015 | X | 16,400 | D | Oct 16, 2005 | Apr 16, 2015 | Common Stock | 16,400 | 83,600 | D |
Explanation of responses
- F1The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 Plan adopted by the reporting person on December 3, 2014.
- F2The price recorded in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $80.255 to $81.065, inclusive. The reporting person undertakes to provide ICU Medical, Inc., any security holder of ICU Medical, Inc., or the staff of the 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 Form 4.
- F3Transaction is the exercise of a derivative security; see Column 2.