-----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, FuBS32cPr3/mWvAuTtitg28jl5x5hsHEaNqZa0krEAaiLy5EWzbYltvi83Fw5Kv7 nqYUTWqO0voDa96thFXnlg== 0000064670-02-000084.txt : 20020904 0000064670-02-000084.hdr.sgml : 20020904 20020904122506 ACCESSION NUMBER: 0000064670-02-000084 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20020901 FILED AS OF DATE: 20020904 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07707 FILM NUMBER: 02756156 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: 4 BUSINESS ADDRESS: STREET 1: 295 MAPLE AVE CITY: BASKING RIDGE STATE: NJ ZIP: 07920 BUSINESS PHONE: 9082217020 4 1 jackson090102form4.txt SHIRLEY ANN JACKSON 090102 FORM 4 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 09/01/2002 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/ +-------+-----+-----------+------+----------+ Month | Indirect| Owner- | | | Year) |Code |V |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) |Code |V |(A) |(D) |cisable |tion Date |Title |Shares |Security |Month |(I) |ship | +-------------+--------+----------+------+--+-----+-----+----------+----------+-------+--------+----------+--------+-------+-------+ Stock Options $41.18 08/31/2002 A 2915 08/31/2002 08/31/2012 Common 2915 $0.0000 2915 D (Right to buy) Stock Stock Options $41.18 09/01/2002 A 1458 09/01/2002 09/01/2012 Common 1458 $0.0000 1458 D (Right to buy) Stock Right to $0 08/31/2002 A 733.8 Common 733.855 $0.0000 733.855 D Receive Stock 55 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/Carol E. Malkinson, Attorney-in-fact __________________________ Shirley Ann Jackson, Ph.D. DATE 09/04/2002
EX-24 3 jacksonpoa.txt SHIRLEY ANN JACKSON POWER OF ATTORNEY Power of Attorney I, Shirley Ann Jackson, 710 Medtronic Parkway, Minneapolis, MN 55432-5604 do hereby appoint: David J. Scott, Senior Vice President, General Counsel and Corporate Secretary Medtronic, Inc., 710 Medtronic Parkway, Minneapolis, MN 55432-5604 Richard F. Hamm, Jr., Vice President and Deputy General Counsel, Medtronic, Inc., 710 Medtronic Parkway, Minneapolis, MN 55432-5604 Gary A. Nelson, Vice President, Risk Management and Legal Administrative Services Medtronic, Inc., 710 Medtronic Parkway, Minneapolis, MN 55432-5604 Carol E. Malkinson, Senior Legal Counsel and Assistant Secretary Medtronic, Inc. 710 Medtronic Parkway, Minneapolis, MN 55432- 5604 As attorney-in-fact in my name, place and stead to act individually in any way which I myself could do, if I were personally present, with respect to the filing of reports as required under Section 16(a) of the Securities Exchange Act of 1934, including Forms 3, 4 and 5, and under Rule 144 of the Securities Act of 1933. In Witness Whereof, I have hereunder set my name this 29 day of August, 2002. /s/ Shirley Ann Jackson Shirley Ann Jackson Specimen Signature of Attorney(s)-in-Fact /s/ David J. Scott David J. Scott /s/ Richard F. Hamm, Jr. Richard F. Hamm, Jr. /s/ Gary A. Nelson Gary A. Nelson /s/ Carol E. Malkinson Carol E. Malkinson STATE OF MINNESOTA ) COUNTY OF ANOKA ) The foregoing instrument was acknowledged before me this 29 day of August, 2002. /s/ Sonja S. Bornus Sonja S. Bornus
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