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*
Krakowiak Maxwell

(Last) (First) (Middle)
940 WINTER STREET

(Street)
WALTHAM MA 02451-1457

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/06/2022
3. Issuer Name and Ticker or Trading Symbol
PERKINELMER INC [ PKI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Please See Remarks
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 970 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
NQ Stock Option (Right to Buy) (1) 03/05/2028 Common Stock 1,196 $123.43 D
NQ Stock Option (Right to Buy) (2) 08/16/2028 Common Stock 5,000 $183.35 D
NQ Stock Option (Right to Buy) (3) 03/04/2029 Common Stock 1,547 $175.39 D
Explanation of Responses:
1. This option vested as to 1/3 of the underlying shares on February 15, 2022, and is scheduled to vest in two equal installments thereafter on February 15, 2023 and February 15, 2024.
2. This option is scheduled to fully vest on August 16, 2023.
3. This option is scheduled to vest in three equal installments on February 15, 2023, February 15, 2024 and February 15, 2025.
Remarks:
Senior Vice President and Chief Financial Officer Exhibit List: Exhibit 24 - Power of Attorney
/s/ John L. Healy (POA on file) for Maxwell Krakowiak 09/06/2022
** 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.