-----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, IfRQM0rGSiCsB6bgkA9SKgLnW3RPg/a1R96xcgA6R7+Y+7XFb+yL8kSGBSPpIf5U 4QsGNagyOPITrb2yKo1e2A== 0000883984-05-000053.txt : 20051206 0000883984-05-000053.hdr.sgml : 20051206 20051206171523 ACCESSION NUMBER: 0000883984-05-000053 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051205 FILED AS OF DATE: 20051206 DATE AS OF CHANGE: 20051206 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ICU MEDICAL INC/DE CENTRAL INDEX KEY: 0000883984 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 330022692 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92763 BUSINESS PHONE: 949-366-2183 MAIL ADDRESS: STREET 1: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92763 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LOPEZ GEORGE A CENTRAL INDEX KEY: 0001073397 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19974 FILM NUMBER: 051247739 BUSINESS ADDRESS: STREET 1: C/O ICU MEDICAL INC STREET 2: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 BUSINESS PHONE: 9493662183 MAIL ADDRESS: STREET 1: C/O ICU MEDICAL STREET 2: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 4 1 edgardoc.xml PRIMARY DOCUMENT X0202 4 2005-12-05 0 0000883984 ICU MEDICAL INC/DE ICUI 0001073397 LOPEZ GEORGE A C/O ICU MEDICAL 951 CALLE AMANECER SAN CLEMENTE CA 92673 1 1 0 1 Chairman Chairman Common Stock 2005-12-05 4 X 0 37986 10.25 A 52008 D Common Stock 2005-12-05 4 X 0 1200 10.25 A 53208 D Common Stock 2005-12-05 4 X 0 1100 10.25 A 54308 D Common Stock 2005-12-05 4 X 0 384 10.25 A 54692 D Common Stock 2005-12-05 4 X 0 2900 10.25 A 57592 D Common Stock 2005-12-05 4 X 0 6105 10.25 A 63697 D Common Stock 2005-12-05 4 X 0 2408 10.25 A 66105 D Common Stock 2005-12-05 4 X 0 1405 10.25 A 67510 D Common Stock 2005-12-05 4 X 0 2693 10.25 A 70203 D Common Stock 2005-12-05 4 X 0 2091 10.25 A 72294 D Common Stock 2005-12-05 4 X 0 300 10.25 A 72594 D Common Stock 2005-12-05 4 X 0 439 10.25 A 73033 D Common Stock 2005-12-05 4 X 0 200 10.25 A 73233 D Common Stock 2005-12-05 4 S 0 37986 39 D 35247 D Common Stock 2005-12-05 4 S 0 1200 39.01 D 34047 D Common Stock 2005-12-05 4 S 0 1100 39.02 D 32947 D Common Stock 2005-12-05 4 S 0 384 39.03 D 32563 D Common Stock 2005-12-05 4 S 0 2900 39.04 D 29663 D Common Stock 2005-12-05 4 S 0 6105 39.05 D 23558 D Common Stock 2005-12-05 4 S 0 2408 39.06 D 21150 D Common Stock 2005-12-05 4 S 0 1405 39.07 D 19745 D Common Stock 2005-12-05 4 S 0 2693 39.08 D 17052 D Common Stock 2005-12-05 4 S 0 2091 39.09 D 14961 D Common Stock 2005-12-05 4 S 0 300 39.1 D 14661 D Common Stock 2005-12-05 4 S 0 439 39.106 D 14222 D Common Stock 2005-12-05 4 S 0 200 39.12 D 14022 D Common Stock 1186843 I by Partnership Common Stock 23223 I by Trust Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 37986 D 1999-01-30 2007-06-26 Common Stock 37986 137014 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 1200 D 1999-01-30 2007-06-26 Common Stock 1200 135814 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 1100 D 1999-01-30 2007-06-26 Common Stock 1100 134714 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 384 D 1999-01-30 2007-06-26 Common Stock 384 134330 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 2900 D 1999-01-30 2007-06-26 Common Stock 2900 131430 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 6105 D 1999-01-30 2007-06-26 Common Stock 6105 125325 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 2408 D 1999-01-30 2007-06-26 Common Stock 2408 122917 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 1405 D 1999-01-30 2007-06-26 Common Stock 1405 121512 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 2693 D 1999-01-30 2007-06-26 Common Stock 2693 118819 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 2091 D 1999-01-30 2007-06-26 Common Stock 2091 116728 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 300 D 1999-01-30 2007-06-26 Common Stock 300 116428 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 439 D 1999-01-30 2007-06-26 Common Stock 439 115989 D Non-Qualified Stock Option (right to buy) 10.25 2005-12-05 4 X 0 200 D 1999-01-30 2007-06-26 Common Stock 200 115789 D Excludes 22,959 shares held by Diana K. Lopez, M.D. Dr. Lopez disclaims any beneficial interest in the shares held by his wife. Common Stock owned by Lopez Family Trust. Dr. Lopez is trustee and beneficiary of the Family Trust. Except to the extent of his peciuniary interests as beneficiary of the Family Trust, Dr. Lopez disclaims any beneficial ownership of the shares owned by the Family Trust. Transaction is the exercise of a derivative security; see Column 2. By: Lynn DeMartini For: George A. Lopez, M.D. 2005-12-06 -----END PRIVACY-ENHANCED MESSAGE-----