0001225208-17-016635.txt : 20171027
0001225208-17-016635.hdr.sgml : 20171027
20171027174204
ACCESSION NUMBER: 0001225208-17-016635
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171020
FILED AS OF DATE: 20171027
DATE AS OF CHANGE: 20171027
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Owens James
CENTRAL INDEX KEY: 0001443909
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-09225
FILM NUMBER: 171160334
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/A
1
doc4a.xml
X0306
4/A
2017-10-20
2017-10-24
0000039368
FULLER H B CO
FUL
0001443909
Owens James
1200 WILLOW LAKE BOULEVARD
P.O. BOX 64683
ST. PAUL
MN
55164-0683
1
President and CEO
Performance Stock Option (Right-to-Buy)
57.7000
2017-10-20
4
A
0
289684.0000
0.0000
A
2021-01-31
2027-10-20
Common Stock
289684.0000
289684.0000
D
Each performance-based non-qualified stock option represents a contingent right and option to purchase all or any part of an aggregate of 289,684 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. In no event will the maximum number of options granted exceed 289,684.
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.
The insider did not pay any consideration for this option.
In the reporting person's original Form 4 filing, the maximum number of performance-based non-qualified stock options to be earned were incorrectly reported.
/s/ Timothy J. Keenan, Attorney-in-Fact
2017-10-27