0001410442-16-000003.txt : 20160208
0001410442-16-000003.hdr.sgml : 20160208
20160208170559
ACCESSION NUMBER: 0001410442-16-000003
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20160205
FILED AS OF DATE: 20160208
DATE AS OF CHANGE: 20160208
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jain Vivek
CENTRAL INDEX KEY: 0001410442
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-34634
FILM NUMBER: 161396327
MAIL ADDRESS:
STREET 1: ICU MEDICAL, INC.
STREET 2: 951 CALLE AMANECER
CITY: SAN CLEMENTE
STATE: CA
ZIP: 92673
4
1
edgardoc.xml
PRIMARY DOCUMENT
X0306
4
2016-02-05
0
0000883984
ICU MEDICAL INC/DE
ICUI
0001410442
Jain Vivek
951 CALLE AMANECER
SAN CLEMENTE
CA
92673
1
1
0
0
Chairman and CEO
Common Stock
0.0
2016-02-05
4
A
0
11276.0
0.0
A
2018-12-31
Common Stock
11276
11276
D
Common Stock
0.0
2016-02-05
4
A
0
11276.0
0.0
A
2019-02-05
Common Stock
11276
11276
D
These securities are Restricted Stock Units.
There is neither a purchase price nor an exercise price for the Restricted Stock Units.
The vesting for this performance-based restricted stock unit ("PRSU") award is dependent upon the reporting person's earning PRSUs based on the achievement of performance criteria related to the Company's fiscal year 2018 Adjusted EBITDA per share CAGR in comparison to the fiscal year 2015 Adjusted EBITDA per weighted average basic share. The number of shares reported is the target award amount.The reporting person may potentially earn PRSUs ranging from 100% to 300% of the target award amount. The shares subject to the actual earned PRSU award will vest prior to March 15, 2019, the determination date, based on certification of the achievement of the performance criteria.
One third of the Units subject to the award shall vest on each of the first, second, and third anniversaries of the grant date.
By: Paula Darbyshire For: Vivek Jain
2016-02-08
EX-24
2
poavjainpd.txt
EDGAR SUPPORTING DOCUMENT
POWER OF ATTORNEY
Know all by these presents that the undersigned hereby constitutes and appoints
Paula Darbyshire, and with full power of substitution, as the undersigned's
true and lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned, in the undersigned's
capacity as an officer and/or director of ICU Medical, Inc., a Delaware
corporation (the "Company"), Forms 3, 4, and 5 in accordance with Section
16(a) of the Securities Exchange Act of 1934 and the rules thereunder;
(2) do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any such Form
3, 4, or 5, complete and execute any amendment or amendments thereto, and
timely file such form with the U.S. Securities and Exchange Commission
(the "SEC") and any stock exchange or similar authority; and
(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of any such attorney-in-fact, may be of benefit
to, in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by any such attorney-in-fact on behalf
of the undersigned pursuant to this Power of Attorney shall be in such form
and shall contain such terms and conditions as such attorney-in-fact may
approve in any such attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might
or could do if personally present, with full power of substitution or
revocation, hereby ratifying and confirming all that each such
attorney-in-fact, or each such attorney-in-fact's substitute or substitutes,
shall lawfully do or cause to be done by virtue of this power of attorney and
the rights and powers herein granted. The undersigned acknowledges that the
foregoing attorneys-in-fact, in serving in such capacity at the request of
the undersigned, are not assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with Section 16 of the Securities
Exchange Act of 1934.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to
the undersigned's holdings of and transactions in securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing
delivered to each of the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 9 day of October, 2015.
/s/ Vivek Jain