0001410442-21-000004.txt : 20210203 0001410442-21-000004.hdr.sgml : 20210203 20210203181721 ACCESSION NUMBER: 0001410442-21-000004 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210203 FILED AS OF DATE: 20210203 DATE AS OF CHANGE: 20210203 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jain Vivek CENTRAL INDEX KEY: 0001410442 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34634 FILM NUMBER: 21587768 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 5 1 edgardoc.xml PRIMARY DOCUMENT X0306 5 2021-02-03 0 0 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 2020-09-15 5 G 0 60000 0.0 D 6241 D Common Stock 2020-09-15 5 G 0 60000 0.0 A 60000 I by Trust Non-Qualified Stock Option (right to buy) 58.79 2020-10-30 5 G 0 66000 0.0 D 2018-02-13 2024-02-24 Common Stock 66000 381866 D Non-Qualified Stock Option (right to buy) 58.79 2020-10-30 5 G 0 66000 0.0 A 2018-02-13 2024-02-24 Common Stock 66000 66000 I by Trust This transaction represented a gift of securities from the reporting person to two trusts for the benefit of family members, who share the same household. The reporting person disclaims beneficial ownership of the shares held by the trusts, and this report shall not be deemed as an admission that the reporting person is the beneficial owner of the trust's shares for purposes of Section 16 or for any other purpose. By: Paula Darbyshire, Attorney-in-fact For: Vivek Jain 2021-02-03