-----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, UP9X9HmrSOI/R2eFkxJ0JroamI4ZrfsTQuUZj87hwQNE7vpplR/K96EsKSvFvSMP c4jQK9I2Jemlxjnu1+ZCQQ== 0000064670-02-000043.txt : 20020610 0000064670-02-000043.hdr.sgml : 20020610 20020607151559 ACCESSION NUMBER: 0000064670-02-000043 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020426 FILED AS OF DATE: 20020607 COMPANY DATA: COMPANY CONFORMED NAME: WILLIAMS KEITH E CENTRAL INDEX KEY: 0001145155 OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 710 MEDTRONIC PKWY MS LC310 CITY: MINNEAPOLIS STATE: MN ZIP: 55432-5604 BUSINESS PHONE: 7635144000 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: 02673624 BUSINESS ADDRESS: STREET 1: 710 MEDTRONIC PKWY STREET 2: MS LC300 CITY: MINNEAPOLIS STATE: MN ZIP: 55432 BUSINESS PHONE: 7635144000 5 1 keithwilliamsfy02form5.txt KEITH WILLIAMS FY02 FORM 5 1. Name and Address of Reporting Person Williams, Keith E. Medtronic, Inc. 710 Medtronic Pkwy Minneapolis, MN 55432- 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) ( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Sr. Vice President & Chief Quality Officer 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 6690.205 D Common Stock 916.571 I By ESOP
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 $43.5 10/25/2001 A 50575 10/25/2002 10/25/2011 Common 50575 $0.0000 50575 D (Right to buy) Stock Stock Options $43.81 04/26/2002 A 16106 04/26/2002 04/26/2012 Common 16106 $0.0000 16106 D (Right to buy) Stock Stock Options $47.8 06/28/2001 A 31381 06/28/2003 06/28/2011 Common 31381 $0.0000 31381 D (Right to buy) Stock Right to $0 04/26/2002 A 225.5 Common 225.509 $0.0000 225.509 D Receive Stock 09 Stock Explanation of Responses: Includes 454 shares acquired under the 1995 Employees Stock Purchase Plan on November 1, 2001. Also reflects transfer of 1226 shares pursuant to Domestic Relations Order. These options become exercisable at the rate of 25% of the shares granted per year beginning on the first anniversary of grant. These options become exercisable at a rate of 50% on the second anniversary of the grant date and 25% on the third and fourth anniversary. Rights acquired under the Medtronic, Inc. Executive Non-qualified Supplemental Benefit Plan to be settled in Medtronic common stock as a 1-for-1 conversion upon the employee's retirement or other termination of employment.
SIGNATURE OF REPORTING PERSON /s/ Keith E. Williams DATE 06/06/2002 -----END PRIVACY-ENHANCED MESSAGE-----