0001287151-17-000064.txt : 20170601 0001287151-17-000064.hdr.sgml : 20170601 20170601171324 ACCESSION NUMBER: 0001287151-17-000064 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20170530 FILED AS OF DATE: 20170601 DATE AS OF CHANGE: 20170601 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: XERIUM TECHNOLOGIES INC CENTRAL INDEX KEY: 0001287151 STANDARD INDUSTRIAL CLASSIFICATION: BROADWOVEN FABRIC MILS, MAN MADE FIBER & SILK [2221] IRS NUMBER: 421558674 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 14101 CAPITAL BOULEVARD CITY: YOUNGSVILLE STATE: NC ZIP: 27596 BUSINESS PHONE: 919-526-1400 MAIL ADDRESS: STREET 1: 14101 CAPITAL BOULEVARD CITY: YOUNGSVILLE STATE: NC ZIP: 27596 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bly Michael CENTRAL INDEX KEY: 0001575017 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32498 FILM NUMBER: 17885613 MAIL ADDRESS: STREET 1: C/O XERIUM TECHNOLOGIES, INC. STREET 2: 8537 SIX FORKS RD., SUITE 300 CITY: RALEIGH STATE: NC ZIP: 27615 4 1 wf-form4_149635158855067.xml FORM 4 X0306 4 2017-05-30 0 0001287151 XERIUM TECHNOLOGIES INC XRM 0001575017 Bly Michael C/O XERIUM TECHNOLOGIES, INC. 14101 CAPITAL BOULEVARD YOUNGSVILLE NC 27596 0 1 0 0 EVP of Global Human Resources Phantom Stock Unit 2017-05-30 4 A 0 28426 0 A Common Stock 28426.0 28426 D Each Phantom Stock Unit is the economic equivalent of one share of Xerium Technologies, Inc. common stock. Subject to time and performance conditions and early vesting in limited circumstances, on 5/30/2020, the Phantom Stock Units will be settled in cash equal to the average closing price of the common stock for the 30-days preceding 5/30/2020. No shares of common stock will be issued in connection with the settlement of the Phantom Stock Units. /s/ Phillip Kennedy, by power of attorney 2017-06-01 EX-24 2 section16powerofattorney-b.htm PK-POA BLY


LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned hereby constitutes and appoints Phillip Kennedy, with full power of substitution, the undersigned's true and lawful attorney-in-fact to:


      1. execute for and on behalf of the undersigned, in the undersigned's capacity as an officer of Xerium Technologies, Inc. (the "Company"), Forms 3, 4 and 5 (and any amendments thereto) in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), and the rules thereunder;

      2. do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4 or 5, complete and execute any amendments thereto, and timely file such form with the U.S. Securities and Exchange Commission (the "SEC") and any securities exchange or similar authority, including without limitation the filing of a Form ID or any other documents necessary or appropriate to enable the undersigned to file the Forms 3, 4 and 5 electronically with the SEC;

      3. seek or obtain, as the undersigned's representative and on the undersigned's behalf, information on transactions in the Company's securities from any third party, including brokers, employee benefit plan administrators and trustees, and the undersigned hereby authorizes any such person to release any such information to the undersigned's attorney-in-fact appointed by this Limited Power of Attorney and approves and ratifies any such release of information; and


      4. take any other action in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by or for, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Limited Power of Attorney shall be in such form and shall contain such information and disclosure as such attorney-in-fact may approve in such attorney-in-fact's discretion.


            The undersigned hereby grants to such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever required, necessary or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this Limited Power of Attorney and the rights and powers herein granted.


            The undersigned acknowledges that the foregoing attorney-in-fact, in serving in such capacity at the request and on the behalf of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with, or any liability for the failure to comply with, any provision of Section 16 of the Exchange Act.

            This Limited Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 or 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorney-in-fact.

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IN WITNESS WHEREOF, the undersigned has executed this Limited Power of Attorney as of this 19th day of January, 2017.


Signed and acknowledged:



/s/ Michael Bly_____
Signature



Michael Bly ________
Printed Name