SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Leach Jacob Steven

(Last) (First) (Middle)
6340 SEQUENCE DRIVE

(Street)
SAN DIEGO CA 92121

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/09/2017
3. Issuer Name and Ticker or Trading Symbol
DEXCOM INC [ DXCM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
SVP, Research & Development
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 105,933(1) D
Common Stock 12,000 I Family Holdings(2)
Common Stock 50,100 I by Spouse(3)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Incentive Stock Option (right to buy) (4) 12/11/2018 Common Stock 10,577 $3.19 D
Incentive Stock Option (right to buy) (4) 10/02/2018 Common Stock 25,000 $5.92 D
Incentive Stock Option (right to buy) (4) 11/20/2019 Common Stock 4,797 $7.27 D
Incentive Stock Option (right to buy) (4) 05/19/2018 Common Stock 7,500 $7.63 D
Incentive Stock Option (right to buy) (4) 02/18/2020 Common Stock 11,458 $9.78 D
Non-Qualified Stock Option (right to buy) (4) 12/11/2018 Common Stock 1,923 $3.19 D
Non-Qualified Stock Option (right to buy) (4) 11/20/2019 Common Stock 203 $7.27 D
Non-Qualified Stock Option (right to buy) (4) 02/18/2020 Common Stock 8,542 $9.78 D
Explanation of Responses:
1. Included in this number are 57,800 unvested restricted stock units, 23,134 of which were granted on March 8, 2017 and shall vest through March 8, 2020, 21,333 of which were granted on March 8, 2016 shall vest through March 8, 2019 and 13,333 of which were granted on March 8, 2015 and shall vest through March 8, 2018.
2. Shares are held by the Gregg Family Grandchildren's Trust UAD 12/30/2010, with respect to which the reporting person's spouse is a trustee.
3. Shares are held by the Kyndra S. Leach Trust UAD 12/12/2012, with respect to which the reporting person's spouse is a trustee.
4. Shares subject to the option are fully vested and immediately exercisable.
Remarks:
CONFIRMING STATEMENT: This Statement confirms that the undersigned Jacob Leach, has authorized and designated Steve Pacelli, Kevin Sun, Patrick Murphy and Timothy O'Brien to execute and file on the undersigned's behalf all Forms 3, 4, and 5 (including any amendments thereto) that the undersigned may be required to file with the U.S. Securities and Exchange Commission as a result of the undersigned's ownership of or transactions in securities of DexCom, Inc. The authority of Steve Pacelli, Kevin Sun, Patrick Murphy and Timothy O'Brien under this Statement shall continue until the undersigned is no longer required to file Forms 3, 4, and 5 with regard to the undersigned's ownership of or transactions in securities of DexCom, Inc., unless earlier revoked in writing. The undersigned acknowledges that Steve Pacelli, Kevin Sun, Patrick Murphy and Timothy O'Brien are not assuming any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934. Date: March 14, 2017 /s/ JACOB LEACH Jacob Leach
By: Timothy O'Brien For: Jacob Leach 03/15/2017
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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