0001410442-19-000004.txt : 20190308 0001410442-19-000004.hdr.sgml : 20190308 20190308130347 ACCESSION NUMBER: 0001410442-19-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190306 FILED AS OF DATE: 20190308 DATE AS OF CHANGE: 20190308 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: 19668474 MAIL ADDRESS: STREET 1: 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 X0306 4 2019-03-06 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 2019-03-06 4 M 0 36509 0.0 A 87093 D Common Stock 2019-03-06 4 F 0 18102 0.0 D 68991 D Common Stock 2019-03-06 4 M 0 11276 0.0 D 2019-03-06 Common Stock 33828 0 D Common Stock 2019-03-06 4 M 0 2681 0.0 D 2021-03-06 Common Stock 2681 5362 D Common Stock 2019-03-06 4 A 0 4331 0.0 A 2022-03-06 Common Stock 4331 4331 D These Securities are Performance-based Restricted Stock Units (PRSU). There is neither a purchase price nor an exercise price for the PRSUs. Each PRSU reflects the contingent right to receive a variable number of shares of common stock based on achieving performance goals. At the determination date, based on certification of the achievement of the performance criteria, the reporting person earned 300% of the target award amount. These PRSUs were granted on February 5, 2016. The vesting for these PRSUs is dependent upon 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 reporting person may potentially earn 100% to 300% of the target award amount originally reported on the date of grant. These securities are Restricted Stock Units. There is neither a purchase price nor an exercise price for the Restricted Stock Units. 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: Alejandro Parras, Attorney-In-Fact For: Vivek Jain 2019-03-08