0001225208-17-016517.txt : 20171024 0001225208-17-016517.hdr.sgml : 20171024 20171024174511 ACCESSION NUMBER: 0001225208-17-016517 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171020 FILED AS OF DATE: 20171024 DATE AS OF CHANGE: 20171024 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: JENSEN TRACI L CENTRAL INDEX KEY: 0001533627 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09225 FILM NUMBER: 171151717 MAIL ADDRESS: STREET 1: 1200 WILLOW LAKE BOULEVARD STREET 2: P.O. BOX 64683 CITY: ST. PAUL STATE: MN ZIP: 55164-0683 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FULLER H B CO CENTRAL INDEX KEY: 0000039368 STANDARD INDUSTRIAL CLASSIFICATION: ADHESIVES & SEALANTS [2891] IRS NUMBER: 410268370 STATE OF INCORPORATION: MN FISCAL YEAR END: 1203 BUSINESS ADDRESS: STREET 1: 1200 WILLOW LAKE BLVD CITY: ST PAUL STATE: MN ZIP: 55110-5132 BUSINESS PHONE: 6126453401 4 1 doc4.xml X0306 4 2017-10-20 0000039368 FULLER H B CO FUL 0001533627 JENSEN TRACI L 1200 WILLOW LAKE BOULEVARD P.O. BOX 64683 ST. PAUL MN 55164-0683 1 Sr.VP, Global Const Products Common Stock 14528.0000 D Performance Stock Option (Right-to-Buy) 57.7000 2017-10-20 4 A 0 62552.0000 57.7000 A 2021-01-31 2027-10-20 Common Stock 62552.0000 62552.0000 D Employee Stock Option (Right-to-Buy) 22.2700 2021-01-20 Common Stock 12658.0000 12658.0000 D Employee Stock Option (Right-to-Buy) 23.6800 2020-04-14 Common Stock 6223.0000 6223.0000 D Employee Stock Option (Right-to-Buy) 33.3800 2026-01-19 Common Stock 29832.0000 29832.0000 D Employee Stock Option (Right-to-Buy) 41.0000 2025-01-22 Common Stock 22789.0000 22789.0000 D Employee Stock Option (Right-to-Buy) 48.9200 2024-01-23 Common Stock 16644.0000 16644.0000 D Employee Stock Option (Right-to-Buy) 50.1000 2018-01-26 2027-01-26 Common Stock 23696.0000 23696.0000 D Performance Stock Units 0.0000 2017-01-19 2019-01-19 Common Stock 2335.5900 2335.5900 D Performance Stock Units 0.0000 2018-01-26 2020-01-26 Common Stock 2563.0400 2563.0400 D Restricted Stock Units 0.0000 2019-01-19 Common Stock 2336.6000 2336.6000 D Restricted Stock Units 0.0000 2018-01-22 Common Stock 2047.6500 2047.6500 D Restricted Stock Units 0.0000 2018-01-26 2020-01-26 Common Stock 4296.9500 4296.9500 D Amount includes 24,398 restricted shares that are 100% vested and restricted shares acquired pursuant to a dividend accrual feature. Each performance-based non-qualified stock option represents a contingent right and option to purchase all or any part of an aggregate of 62,552 shares of Common Stock at the price of $57.70 per share. Prior to vesting, the number of options subject to the award will be adjusted based on the company's adjusted EBITDA performance for fiscal year 2020. The number of options may decrease to as low as 0% of the initial number of options depending on the level of adjusted EBITDA performance. The grant amount is shown at the superior level of performance. These performance-based non-qualified stock options vest on the date shown contingent upon H.B. Fuller achieving adjusted EBITDA at least at the threshold level of performance. This option is 100% vested. This option vests in three equal annual installments beginning on January 19, 2017. This option vests in three equal annual installments beginning on January 22, 2016. This option vests in three equal annual installments beginning on the date shown. These performance stock units convert into shares of common stock on a 1-for-1 basis. These performance stock units vest in three equal annual installments beginning on the date shown upon H.B. Fuller achieving return on invested capital at least at the threshold level of performance in each year of the three years of vesting. This amount has been adjusted to reflect the increase in number of performance stock units of the original grant based on performance criteria. Amount also includes performance stock units acquired pursuant to a dividend equivalent reinvestment feature. Amount includes performance stock units acquired pursuant to a dividend equivalent reinvestment feature. These restricted stock units convert into shares of common stock on a 1-for-1 basis. These restricted stock units vest in three equal annual installments beginning on January 19, 2017. Amount includes restricted stock units acquired pursuant to a dividend equivalent reinvestment feature. These restricted stock units vest in three equal annual installments beginning on January 22, 2016. These restricted stock units vest in three equal annual installments beginning on the date shown. /s/ Timothy J. Keenan, Attorney-in-Fact 2017-10-24