0001209191-15-044285.txt : 20150519 0001209191-15-044285.hdr.sgml : 20150519 20150519140551 ACCESSION NUMBER: 0001209191-15-044285 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150505 FILED AS OF DATE: 20150519 DATE AS OF CHANGE: 20150519 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: Negro Renato CENTRAL INDEX KEY: 0001624125 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-36440 FILM NUMBER: 15875917 MAIL ADDRESS: STREET 1: 351 PHELPS DRIVE CITY: IRVING STATE: TX ZIP: 75038 4/A 1 doc4a.xml FORM 4/A SUBMISSION X0306 4/A 2015-05-05 2015-05-07 0 0001606498 Halyard Health, Inc. HYH 0001624125 Negro Renato 5405 WINDWARD PARKWAY ALPHARETTA GA 30004 0 1 0 0 Vice President and Controller Common Stock, $0.01 par value 2015-05-05 4 A 0 686 0.00 A 784 D Common Stock, $0.01 par value 2015-05-05 4 A 0 1450 0.00 A 2234 D Common Stock, $0.01 par value 2015-05-05 4 F 0 544 45.53 D 1690 D Common Stock, $0.01 par value 2015-05-05 4 A 0 824 0.00 A 2514 D Common Stock, $0.01 par value 2015-05-05 4 F 0 137 45.53 D 2377 D Common Stock, $0.01 par value 2015-05-05 4 A 0 1288 0.00 A 3665 D Common Stock, $0.01 par value 2015-05-05 4 F 0 150 45.53 D 3515 D Common Stock, $0.01 par value 2015-05-05 4 A 0 1095 0.00 A 4610 D Common Stock, $0.01 par value 2015-05-05 4 F 0 356 45.53 D 4254 D Common Stock, $0.01 par value 2015-05-05 4 A 0 887 0.00 A 5141 D Common Stock, $0.01 par value 2015-05-05 4 A 0 1816 0.00 A 6957 D Represents time-vested restricted stock units issued pursuant to the Halyard Health Equity Participation Plan which will vest on May 5, 2018, subject to earlier vesting in the event of death, disability or certain other events. On the initial Form 4, the amount listed in Item 5 did not include 98 shares of stock that the Reporting Person owned, and, among other things, this amendment is being filed to correct the beneficial ownership amount held by the Reporting Person following this transaction. Represents time-vested restricted stock units issued pursuant to the Halyard Health, Inc. Equity Participation Plan which will vest immediately. This transaction represents the withholding of 544 shares of common stock to satisfy the tax withholding obligations incurred by the Reporting Person upon the vesting of 1,450 shares of common stock awarded to the Reporting Person on May 5, 2015. The initial Form 4 incorrectly reflected the shares withheld for taxes as 484 shares. Represents time-vested restricted stock issued pursuant to the Halyard Health Equity Participation Plan of which 354 shares will vest immediately and 470 will vest on May 1, 2016. This transaction represents the withholding of 137 shares of common stock to satisfy the tax withholding obligations incurred by the Reporting Person upon the vesting of 354 shares of common stock awarded to the Reporting Person on May 5, 2015. The initial Form 4 incorrectly reflected the shares withheld for taxes as 118 shares. Represents time-vested restricted stock units of which 386 of the awards will vest immediately, 386 of the awards will vest on May 1, 2016, and 516 of the awards will vest on May 1, 2017, subject to earlier vesting in the event of death, disability or other certain events. This transaction represents the withholding of 150 shares of common stock to satisfy the tax withholding obligations incurred by the Reporting Person upon the vesting of 386 shares of common stock awarded to the Reporting Person on May 5, 2015. The initial Form 4 incorrectly reflected the shares withheld for taxes as 129 shares. This transaction represents the withholding of 356 shares of common stock to satisfy the tax withholding obligations incurred by the Reporting Person upon the vesting of 1,095 shares of common stock awarded to the Reporting Person on May 5, 2015. The original Form 4 incorrectly reflected the shares withheld for taxes as 365 shares. Represents time-vested restricted stock units issued pursuant to the Halyard Health, Inc. Equity Participation Plan which will vest on May 1, 2016, subject to earlier vesting in the event of death, disability or certain other events. Represents time-vested restricted stock units issued pursuant to the Halyard Health, Inc. Equity Participation Plan which will vest on May 1, 2017, subject to earlier vesting in the event of death, disability or certain other events. This Form 4A amends Table I of the Form 4 filed on May 7, 2015, in its entirety. /s/ S. Ross Mansbach, Attorney-in-Fact for Renato Negro 2015-05-19