0001127602-21-021212.txt : 20210702 0001127602-21-021212.hdr.sgml : 20210702 20210702160843 ACCESSION NUMBER: 0001127602-21-021212 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210514 FILED AS OF DATE: 20210702 DATE AS OF CHANGE: 20210702 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: 211070055 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 2021-05-14 0001145197 INSULET CORP PODD 0001631895 Petrovic Shacey C/O INSULET CORPORATION 100 NAGOG PARK ACTON MA 01720 1 1 President and CEO Common Stock 2021-05-14 5 G 0 E 25905 0 D 15684 D Common Stock 2021-05-14 5 G 0 E 25905 0 A 25905 I By SP Trust Common Stock 2021-07-01 4 M 0 15000 30.58 A 30779 D Common Stock 2021-07-01 4 S 0 15000 278.56 D 15779 D Common Stock 87495 I By NG Trust Employee Stock Option (Right to Buy) 30.58 2021-07-01 4 M 0 15000 0 D 2025-02-09 Common Stock 15000 7436 D On May 14, 2021, the reporting person gifted 25,905 shares of Insulet common stock to a family trust of which the reporting person is the settlor and a trustee. The beneficiaries of the trust are members of the reporting person's immediate family. The transactions reported in this Form 4 were effected pursuant to an existing Rule 10b5-1 trading plan. Includes 95 shares acquired under the Insulet Corporation Employee Stock Purchase Plan on May 28, 2021. The price reported represents the weighted average sale price of the shares sold. The shares were sold at varying prices in the range of $274.695 to $280.55. The Reporting Person hereby undertakes, upon request of the Staff of the U.S. Securities Exchange Commission, the Issuer or a security holder of the Issuer, to provide full information regarding the number of shares sold at each separate price. 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 2021-07-02