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