SEC Form 4 · accession 0001615186-16-000003
ICU MEDICAL INC/DE · ICUI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Thomas D McCall
Officer — Vice President and Gen'l Mgr.
Period of report
Feb 5, 2016
Accepted (ET)
Feb 8, 2016 · 4:53 pm EST
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,F2,F3 | $0.00 | Feb 5, 2016 | A | 2,037 | A | — | Dec 31, 2018 | Common Stock | 2,037 | 2,037 | D |
| Common StockF1,F2,F4 | $0.00 | Feb 5, 2016 | A | 2,037 | A | — | Feb 5, 2019 | Common Stock | 2,037 | 2,037 | 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 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 2018 Adjusted EBITDA per share CAGR in comparison to the fiscal year 2015 Adjusted EBITDA per weighted average basic share. 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. The shares subject to the actual earned PRSU award will vest prior to March 15, 2019, the determination date, based on certification of the achievement of the performance criteria.
- F4One third of the Units subject to the award shall vest on each of the first, second, and third anniversaries of the grant date.