SEC Form 4 · accession 0001669639-16-000003
ICU MEDICAL INC/DE · ICUI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Virginia Ruth Sanzone
Officer — VP, General Counsel
Period of report
Aug 24, 2016
Accepted (ET)
Sep 13, 2016 · 4:18 pm EDT
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 | Aug 24, 2016 | M | 3,049 | $0.00 | A | 3,049 | D | |
| Common Stock | Aug 24, 2016 | F | 1,146 | $0.00 | D | 1,903 | D | |
| Common StockF1,F3 | Sep 12, 2016 | S | 1,903 | $121.2949 | D | 0 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common StockF1,F4,F5 | $0.00 | Aug 24, 2016 | M | 3,049 | D | — | Aug 24, 2018 | Common Stock | 3,049 | 6,098 | D |
Explanation of responses
- F1These securities are Restricted Stock Units.
- F2The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 Plan adopted by the reporting person on August 11, 2016.
- F3The price reported in Column 4 is an average weighted price. These shares were sold in multiple transactions at prices ranging from $121.11 to $121.31, 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.
- F4There is neither a purchase price nor an exercise price for the Restricted Stock Units.
- F5One third of the Units subject to the award shall vest on each of the first, second, and third anniversaries of the grant date.