-----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, OZCEJPops1xgtRG96tHLVWRYLyinCrnK4CXohGwmYQfWpKq71YU7jz3bRuqk+tzG ly9yuymSu0urMpCm4XJuhg== 0000064670-02-000028.txt : 20020610 0000064670-02-000028.hdr.sgml : 20020610 20020606175515 ACCESSION NUMBER: 0000064670-02-000028 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020426 FILED AS OF DATE: 20020607 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: 02672791 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: CHELLGREN PAUL W CENTRAL INDEX KEY: 0001023533 DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: PO BOX 391 CITY: ASHLAND STATE: KY ZIP: 41114 BUSINESS PHONE: 6063293333 MAIL ADDRESS: STREET 1: C/O ASHLAND INC STREET 2: 1000 ASHLAND DRIVE PO BOX 391 CITY: RUSSELL STATE: KY ZIP: 41169 5 1 chellgrenfy02form5.txt PAUL W CHELLGREN FY02 FORM 5 1. Name and Address of Reporting Person Chellgren, Paul W. Ashland, Inc. 50 E RiverCenter Blvd Covington, KY 41012-0391 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 | +---------------------------------+----------+-------------+-----------+------+----------+----------------+-----------+------------+ Common Stock 2000 D
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 $45.54 08/31/2001 A 5271 08/31/2001 08/31/2011 Common 5271 $0.0000 5271 D (Right to buy) Stock Stock Options $45.54 09/01/2001 A 1318 09/01/2001 09/01/2011 Common 1318 $0.0000 1318 D (Right to buy) Stock Right to $0 08/31/2001 A 670.5 Common 670.533 $0.0000 670.533 D Receive Stock 33 Stock Explanation of Responses: Deferred units credited under the Medtronic, Inc. Outside Director's Compensation Plan to be paid in Medtronic common stock upon the director's resignation or retirement.
SIGNATURE OF REPORTING PERSON /s/ Paul W. Chellgren DATE 06/06/2002 -----END PRIVACY-ENHANCED MESSAGE-----