0001615186-19-000006.txt : 20190308 0001615186-19-000006.hdr.sgml : 20190308 20190308130725 ACCESSION NUMBER: 0001615186-19-000006 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: McCall Thomas D CENTRAL INDEX KEY: 0001615186 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34634 FILM NUMBER: 19668487 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 0001615186 McCall Thomas D 951 CALLE AMANECER SAN CLEMENTE CA 92673 0 1 0 0 Vice President and Gen'l Mgr. Common Stock 2019-03-06 4 M 0 6111 0.0 A 9001 D Common Stock 2019-03-06 4 F 0 2791 0.0 D 6210 D Common Stock 2019-03-06 4 M 0 2037 0.0 D 2019-03-06 Common Stock 6111 0 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. By: Alejandro Parras, Attorney-In-Fact For: Thomas D. McCall 2019-03-08