0001127602-19-033199.txt : 20191119 0001127602-19-033199.hdr.sgml : 20191119 20191119161039 ACCESSION NUMBER: 0001127602-19-033199 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191115 FILED AS OF DATE: 20191119 DATE AS OF CHANGE: 20191119 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Petrovic Shacey CENTRAL INDEX KEY: 0001631895 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33462 FILM NUMBER: 191231264 MAIL ADDRESS: STREET 1: 600 TECHNOLOGY PARK DRIVE STREET 2: SUITE 200 CITY: BILLERICA STATE: MA ZIP: 01821 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: INSULET CORP CENTRAL INDEX KEY: 0001145197 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 043523891 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 NAGOG PARK CITY: ACTON STATE: MA ZIP: 01720 BUSINESS PHONE: 978-600-7000 MAIL ADDRESS: STREET 1: 100 NAGOG PARK CITY: ACTON STATE: MA ZIP: 01720 4 1 form4.xml PRIMARY DOCUMENT X0306 4 2019-11-15 0001145197 INSULET CORP PODD 0001631895 Petrovic Shacey C/O INSULET CORPORATION 100 NAGOG PARK ACTON MA 01720 1 1 President and CEO Common Stock 2019-11-15 4 M 0 3417 29.26 A 97927 D Common Stock 2019-11-15 4 F 0 554 180.22 D 97373 D Common Stock 2019-11-15 5 G 0 E 835 0 D 96538 D Employee Stock Option (Right to Buy) 29.26 2019-11-15 4 M 0 3417 0 D 2026-02-24 Common Stock 3417 48051 D Constitutes previously owned shares to cover the exercise price of the option being exercised through a stock swap. This option is subject to a four-year vesting period with 25% of the total award vesting one year after the grant date and the remainder vesting in equal quarterly installments each quarter thereafter for 12 quarters, subject to continued employment. /s/ John W. Kapples, attorney-in-fact 2019-11-19