0000883984-12-000072.txt : 20120523 0000883984-12-000072.hdr.sgml : 20120523 20120523114844 ACCESSION NUMBER: 0000883984-12-000072 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120521 FILED AS OF DATE: 20120523 DATE AS OF CHANGE: 20120523 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KOVALCHIK MICHAEL T CENTRAL INDEX KEY: 0001073390 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34634 FILM NUMBER: 12863516 MAIL ADDRESS: STREET 1: C/O ICU MEDICAL INC STREET 2: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 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: 92763-6212 BUSINESS PHONE: 949-366-2183 MAIL ADDRESS: STREET 1: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92763-6212 4 1 edgardoc.xml PRIMARY DOCUMENT X0305 4 2012-05-21 0 0000883984 ICU MEDICAL INC/DE ICUI 0001073390 KOVALCHIK MICHAEL T 951 CALLE AMANECER SAN CLEMENTE CA 92673 1 0 0 0 Common Stock 2012-05-21 4 X 0 1875.0 28.635 A 4637.0 D Common Stock 2012-05-21 4 S 0 1875.0 52.2993 D 2762.0 D Common Stock 2012-05-21 4 X 0 1875.0 30.625 A 4637.0 D Common Stock 2012-05-21 4 S 0 1875.0 52.2993 D 2762.0 D Common Stock 2012-05-21 4 X 0 1875.0 28.8133 A 4637.0 D Common Stock 2012-05-21 4 S 0 1875.0 52.68 D 2762.0 D Common Stock 2012-05-21 4 X 0 1875.0 30.295 A 4637.0 D Common Stock 2012-05-21 4 S 0 1875.0 52.2993 D 2762.0 D Non-Qualified Stock Option (right to buy) 28.635 2012-05-21 4 X 0 1875.0 D 2004-02-16 2014-08-16 Common Stock 1875.0 0.0 D Non-Qualified Stock Option (right to buy) 28.8133 2012-05-21 4 X 0 1875.0 D 2002-05-02 2012-11-02 Common Stock 1875.0 0.0 D Non-Qualified Stock Option (right to buy) 30.295 2012-05-21 4 X 0 1875.0 D 2003-08-16 2014-02-06 Common Stock 1875.0 0.0 D Non-Qualified Stock Option (right to buy) 30.625 2012-05-21 4 X 0 1875.0 D 2003-11-16 2014-05-16 Common Stock 1875.0 0.0 D The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $52.00 to $52.5601, inclusive. The reporting person undertakes to provide ICU Medical, Inc., any security holder of ICU Medical, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each price within the range set forth in this Form 4. The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $52.60 to $52.75, inclusive. The reporting person undertakes to provide ICU Medical, Inc., any security holder of ICU Medical, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each price within the range set forth in this Form 4. Transaction is the exercise of a derivative security; see Column 2. By: Lynn DeMartini For: Michael T. Kovalchik, III, M.D. 2012-05-23