0001615186-17-000003.txt : 20170403 0001615186-17-000003.hdr.sgml : 20170403 20170403210641 ACCESSION NUMBER: 0001615186-17-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170327 FILED AS OF DATE: 20170403 DATE AS OF CHANGE: 20170403 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: McCall Thomas D CENTRAL INDEX KEY: 0001615186 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34634 FILM NUMBER: 17736036 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 2017-03-27 0 0000883984 ICU MEDICAL INC/DE ICUI 0001615186 McCall Thomas D 951 CALLE AMANECER SAN CLEMENTE CA 92673 0 1 0 0 Vice President and Gen'l Mgr. Common Stock 0.0 2017-03-27 4 A 0 1051 0.0 A 2019-12-31 Common Stock 1051 1051 D Common Stock 0.0 2017-03-27 4 A 0 1051 0.0 A 2020-03-27 Common Stock 1051 1051 D These securities are Restricted Stock Units. There is neither a purchase price nor an exercise price for the Restricted Stock Units. The executive officers were notified of their awards by the Registrant on March 30, 2017. 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 2019 Cumulative Adjusted EBITDA in comparison to the fiscal year 2016 Adjusted EBITDA. 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. 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, Attorney-in-fact For: Thomas D. McCall 2017-04-03