-----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, L5st6Bx+nlhYQlqw2nVWAefsAQ0HhLugULkEYb0z3OcH4Kf91KEnKieb3gsK/6eX Amp5gw1eCqmF/3wH7d4t2w== 0001223623-04-000042.txt : 20041005 0001223623-04-000042.hdr.sgml : 20041005 20041005115339 ACCESSION NUMBER: 0001223623-04-000042 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041001 FILED AS OF DATE: 20041005 DATE AS OF CHANGE: 20041005 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WIJNBERG SANDRA S CENTRAL INDEX KEY: 0001194455 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13836 FILM NUMBER: 041064876 BUSINESS ADDRESS: STREET 1: MARSH & MCLENNAN COS INC STREET 2: 1166 AVE OF THE AMERICAS CITY: NEW YORK STATE: NY ZIP: 10036 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: TYCO INTERNATIONAL LTD /BER/ CENTRAL INDEX KEY: 0000833444 STANDARD INDUSTRIAL CLASSIFICATION: ELECTRONIC CONNECTORS [3678] IRS NUMBER: 000000000 STATE OF INCORPORATION: D0 FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: 90 PITTS BAY ROAD STREET 2: THE ZURICH CENTRE SECOND FLOOR CITY: PEMROKE HM 08 BERMU STATE: D0 BUSINESS PHONE: 4412928674 MAIL ADDRESS: STREET 1: C/O TYCO INTERNATIONAL (US) INC STREET 2: ONE TYCO PARK CITY: EXETER STATE: NH ZIP: 03833 FORMER COMPANY: FORMER CONFORMED NAME: ADT LIMITED DATE OF NAME CHANGE: 19930601 4 1 wij285.xml X0202 4 2004-10-01 0 0000833444 TYCO INTERNATIONAL LTD /BER/ TYC 0001194455 WIJNBERG SANDRA S C/O TYCO INTERNATIONAL (US) INC. 9 ROSZEL ROAD PRINCETON NJ 08540 1 0 0 0 Deferred Stock Unit 0.00 2004-10-01 4 A 0 3884 0 A 2003-10-01 Common Shares 3884 9859 D Defered Stock Units (DSUs) were issued under the Tyco International Ltd. (the Company) 2004 Stock and Incentive Plan (the Plan) at a DSU value based on the average price of Tyco common stock for the 60-days prior to the grant. The DSUs are immediately vested upon grant. Dividends will be credited in DSUs to the grantee's account based on the average of the high and the low sale price of Tyco common stock on the dividend date. Distribution under the Plan will first occur upon (i) 30 days following termination of the grantee's service as a member of the Board of Directors of the Company (except in the event of Termination for Cause), or (ii) a Change in Control. Upon such date of termination or Change in Control, as the case may be, the Company shall issue to the grantee the number of shares of Tyco common stock equal to the aggregate number of vested DSUs credited to the grantee. By: Judith A. Reinsdorf, Attorney-In-Fact 2004-10-04 -----END PRIVACY-ENHANCED MESSAGE-----