-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, C2k5Xqv8zGilyM4iXZYQZSJeX6ZYozOCjcAfphtF0A+oUK8x0ruVf2B9+AmFGGJh ZGXhT9+7ZilIJhMAaJvlsQ== 0000064670-02-000024.txt : 20020607 0000064670-02-000024.hdr.sgml : 20020607 20020606165908 ACCESSION NUMBER: 0000064670-02-000024 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020426 FILED AS OF DATE: 20020606 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MEDTRONIC INC CENTRAL INDEX KEY: 0000064670 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 410793183 STATE OF INCORPORATION: MN FISCAL YEAR END: 0430 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07707 FILM NUMBER: 02672554 BUSINESS ADDRESS: STREET 1: 710 MEDTRONIC PKWY STREET 2: MS LC300 CITY: MINNEAPOLIS STATE: MN ZIP: 55432 BUSINESS PHONE: 7635144000 COMPANY DATA: COMPANY CONFORMED NAME: JACKSON SHIRLEY A CENTRAL INDEX KEY: 0001168019 DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 295 MAPLE AVE CITY: BASKING RIDGE STATE: NJ ZIP: 07920 BUSINESS PHONE: 9082217020 5 1 jacksonfy02form5.txt SHIRLEY ANN JACKSON PH.D. FY02 FORM 5 1. Name and Address of Reporting Person Jackson, Ph.D., Shirley Ann Rensselaer Polytechnic Institute 110 8th St Troy Building Troy, NY 12180 United States 2. Issuer Name and Ticker or Trading Symbol Medtronic, Inc. (MDT) 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year 2002 5. If Amendment, Date of Original (Month/Day/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director ( ) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 7. 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 Acquired, Disposed of, or Beneficially Owned
+---------------------------------+----------+-------------+-----------------------------+----------------+-----------+------------+ |1. Title of Security |2. Trans- |3. Trans- |4. Securities Acquired (A) |5. Amount of |6. Owner- |7. Nature | | | action | action | or Disposed of (D) | Securities | ship | of In- | | | Date | Code | | Beneficially | Form: | direct | | | | | | Owned at | Direct | Bene- | | | (Month/ | | | End of | (D) or | ficial | | | Day/ | +-----------+------+----------+ Year | Indirect| Owner- | | | Year) | |Amount |A/D |Price | | (I) | ship | +---------------------------------+----------+-------------+-----------+------+----------+----------------+-----------+------------+
TABLE II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
+-------------+--------+----------+---------+-----------+---------------------+----------------+----------+--------+-------+-------+ |1. |2. |3. |4. |5. |6. |7. |8. |9. |10. |11. | | | | | | | | | |Number |Owner- | | | | | | | | | | |of |ship | | | | | | | | | | |Deriv- |Form of| | | | | | | | |Title and Amount| |ative |Deriv- | | | | | | | | |of Underlying | |Secur- |ative |Nature | | |Conver- | | |Number of | |Securities | |ities |Secur- |of | | |sion or | | |Derivative |Date Exercisable +-------+--------+ |Benefi- |ity: |In- | | |Exercise| | |Securities |and Expiration Date | |Amount | |cially |Direct |direct | | |Price of|Transac- |Transac- |Acquired(A)|(Month/Day/Year) | |or | |Owned |(D) or |Bene- | |Title of |Deriv- |tion Date |tion Code|Disposed(D)+----------+----------+ |Number |Price of |at End |In- |ficial | |Derivative |ative |(Month/ | +-----+-----+Date Exer-|Expira- | |of |Derivative|of |direct |Owner- | |Security |Security|Day/Year) | |(A) |(D) |cisable |tion Date |Title |Shares |Security |Year |(I) |ship | +-------------+--------+----------+---------+-----+-----+----------+----------+-------+--------+----------+--------+-------+-------+ Stock Options $49 01/24/2002 A 2449 08/29/2002 01/24/2012 Common 2449 $0.0000 2449 D (Right to buy) Stock Explanation of Responses:
SIGNATURE OF REPORTING PERSON /s/ Shirley Ann Jackson, Ph.D. DATE 06/06/2002 -----END PRIVACY-ENHANCED MESSAGE-----