SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Sarker Arjun Ranjan

(Last) (First) (Middle)
5405 WINDWARD PARKWAY

(Street)
ALPHARETTA GA 30004

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/02/2018
3. Issuer Name and Ticker or Trading Symbol
Avanos Medical, Inc. [ AVNS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Senior VP, International
5. If Amendment, Date of Original Filed (Month/Day/Year)
05/02/2018
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 4,510(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) 05/03/2018 05/03/2027 Common Stock 2,104(2) $36.74 D
Explanation of Responses:
1. This Form 3/A is being filed to correct the original Form 3 filed on May 2, 2018. The reporting person beneficially owned 4,510 shares at the time the original Form 3 was filed, consisting of (a) 4,000 restricted share units granted on February 2, 2017, with half vesting on the first anniversary of the grant and the balance vesting on the second anniversary, and (b) 510 time-based restricted share units granted on May 3, 2017, vesting on May 3, 2020.
2. The awards were granted on May 3, 2017 and vested, or will vest, 30% on May 3, 2018, 30% on May 3, 2019, and 40% on May 3, 2020, subject to earlier vesting in the event of death, disability or certain other events.
Remarks:
/s/ S.Ross Mansbach, as attorney-in-fact for Arjun R. Sarker 06/05/2019
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.