-----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, AljH00puz6LNAJDNwgfwUguoHWmxKfpTQFVfjQ8rO9TpWeCIrmRtmnLHaHOEKLYv VcHreNsNT2hvH8VeN7nC/A== 0000883984-05-000056.txt : 20051213 0000883984-05-000056.hdr.sgml : 20051213 20051213200912 ACCESSION NUMBER: 0000883984-05-000056 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051213 FILED AS OF DATE: 20051213 DATE AS OF CHANGE: 20051213 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: 051262158 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 2005-12-13 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 2005-12-13 4 X 0 485 10.25 A 14507 D Common Stock 2005-12-13 4 S 0 485 39 D 14022 D Common Stock 1186843 I by Partnership Common Stock 23223 I by Trust Non-Qualified Stock Option (right to buy) 10.25 2005-12-13 4 X 0 485 D 1999-01-30 2007-06-26 Common Stock 485 100000 D Transaction is the exercise of a derivative security; see Column 2. 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. By: Lylnn DeMartini For: George A. Lopez, M.D. 2005-12-13 -----END PRIVACY-ENHANCED MESSAGE-----