SEC Form 4 · accession 0001189727-17-000004
ICU MEDICAL INC/DE · ICUI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Alison D Burcar
Officer — Vice President and Gen'l Mgr.
Period of report
Mar 27, 2017
Accepted (ET)
Apr 3, 2017 · 8:32 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000883984
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common StockF1,F3,F2,F4 | $0.00 | Mar 27, 2017 | A | 1,535 | A | — | Dec 31, 2019 | Common Stock | 1,535 | 1,535 | D |
| Common StockF1,F3,F2,F5 | $0.00 | Mar 27, 2017 | A | 1,535 | A | — | Mar 27, 2020 | Common Stock | 1,535 | 1,535 | D |
Explanation of responses
- F1These securities are Restricted Stock Units.
- F2There is neither a purchase price nor an exercise price for the Restricted Stock Units.
- F3The executive officers were notified of their awards by the Registrant on March 30, 2017.
- F4The vesting for this performance-based restricted stock unit ("PRSU") award is dependent upon the reporting person's earning PRSUs based on the achievement of performance criteria related to the Company's fiscal year 2019 Cumulative Adjusted EBITDA in comparison to the fiscal year 2016 Adjusted EBITDA. The number of shares reported is the target award amount. The reporting person may potentially earn PRSUs ranging from 100% to 300% of the target award amount.
- F5One third of the Units subject to the award shall vest on each of the first, second, and third anniversaries of the grant date.