0001209191-16-089552.txt : 20160106
0001209191-16-089552.hdr.sgml : 20160106
20160106104545
ACCESSION NUMBER: 0001209191-16-089552
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20160104
FILED AS OF DATE: 20160106
DATE AS OF CHANGE: 20160106
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Halyard Health, Inc.
CENTRAL INDEX KEY: 0001606498
STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842]
IRS NUMBER: 464987888
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 5405 WINDWARD PARKWAY
CITY: ALPHARETTA
STATE: GA
ZIP: 30004
BUSINESS PHONE: 678-425-9273
MAIL ADDRESS:
STREET 1: 5405 WINDWARD PARKWAY
CITY: ALPHARETTA
STATE: GA
ZIP: 30004
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BLACKFORD GARY
CENTRAL INDEX KEY: 0001156320
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SPECIALTY OUTPATIENT FACILITIES, NEC [8093]
STATE OF INCORPORATION: MN
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36440
FILM NUMBER: 161325670
MAIL ADDRESS:
STREET 1: 7700 FRANCE AVENUE SOUTH
CITY: EDINA
STATE: MN
ZIP: 55435
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-01-04
0
0001606498
Halyard Health, Inc.
HYH
0001156320
BLACKFORD GARY
5405 WINDWARD PARKWAY
ALPHARETTA
GA
30004
1
0
0
0
Common Stock
2016-01-04
4
A
0
4274
0.00
A
8225
D
Represents restricted share units issued to the reporting person on January 4, 2016 pursuant to the Halyard Health, Inc. Outside Director's Compensation Plan.
/s/ S. Ross Mansbach, as attorney-in-fact for Gary D. Blackford
2016-01-06
EX-24.4_624002
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that the undersigned does hereby constitute and
appoint John W. Wesley, S. Ross Mansbach and Shivani Prabhakar Kaul, and each of
them, with full power to act alone, his true and lawful attorney-in-fact and
agent, with full power of substitution and resubstitution, for his and in his
name, place and stead, in any and all capacities, to execute and acknowledge
Form 144 under the Securities Act of 1933, as amended (the "Securities Act"),
and Rule 144 thereunder, and Forms 3, 4 and 5 pursuant to Section 16(a) of the
Securities Exchange Act of 1934, as amended (the "Exchange Act"), and the rules
and regulations thereunder, any amendments to such forms, and any and all other
documents (and amendments thereto), including, without limitation, Form ID,
necessary or desirable to facilitate the filing by the undersigned of Form 144
and forms under Section 16(a) of the Exchange Act, with respect to securities of
Halyard Health, Inc. (the "Company"), and to deliver and file the same with all
exhibits thereto, and all other documents in connection therewith, to and with
the Securities and Exchange Commission, the national securities exchanges and
the Company, granting unto said attorneys in fact and agents, and each of them,
full power and authority to do and perform each and every act and thing
requisite and necessary to be done, as fully to all intents and purposes as the
undersigned might or could do in person, hereby ratifying and confirming all
that said attorneys in fact and agents or any one of them, or his or her
substitute or their substitutes, lawfully do or cause to be done by virtue
hereof. The undersigned agrees that each of the attorneys in fact herein may
rely entirely on information furnished orally or in writing by the undersigned
to such attorney-in-fact.
The undersigned does hereby revoke in its entirety the Power of Attorney dated
October 20, 2014 that was granted to Thomas J. Mielke, John W. Wesley, Ross
Mansbach, Jeffrey Melucci, Jeffrey S. McFall, Robert F. Westover and Tricia
Kinney, as Attorneys-in-Fact, and withdraws every power and authority conferred
therein.
The validity of this Power of Attorney shall not be affected in any manner by
reason of the execution, at any time, of other powers of attorney by the
undersigned in favor of persons other than those named herein.
This Power of Attorney shall continue in full force and effect until the
undersigned is no longer required to file Form 3, Form 4, Form 5 or Form 144
with regard to the undersigned's ownership of or transactions in securities of
the Company, unless earlier revoked in writing. The undersigned acknowledges
that the foregoing attorneys-in-fact are not assuming any of the undersigned's
responsibilities to comply with Rule 144 under the Securities Act or Section 16
of the Exchange Act.
IN WITNESS WHEREOF, I have hereunto set my hand effective this 24th day of
February 2015.
/s/ Gary D. Blackford
Gary D. Blackford