0001631148-17-000029.txt : 20170907 0001631148-17-000029.hdr.sgml : 20170907 20170907122209 ACCESSION NUMBER: 0001631148-17-000029 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20170830 FILED AS OF DATE: 20170907 DATE AS OF CHANGE: 20170907 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Van Valkenburg Richard CENTRAL INDEX KEY: 0001715675 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-20206 FILM NUMBER: 171073349 MAIL ADDRESS: STREET 1: 47827 HALYARD CITY: PLYMOUTH STATE: MI ZIP: 48170 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PERCEPTRON INC/MI CENTRAL INDEX KEY: 0000887226 STANDARD INDUSTRIAL CLASSIFICATION: OPTICAL INSTRUMENTS & LENSES [3827] IRS NUMBER: 382381442 STATE OF INCORPORATION: MI FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 47827 HALYARD DRIVE CITY: PLYMOUTH STATE: MI ZIP: 48170-2461 BUSINESS PHONE: 3134144816 MAIL ADDRESS: STREET 1: 47827 HALYARD DRIVE CITY: PLYMOUTH STATE: MI ZIP: 48170-2461 3 1 certent-form3.xml PRIMARY DOCUMENT X0206 3 2017-08-30 0 0000887226 PERCEPTRON INC/MI PRCP 0001715675 Van Valkenburg Richard 47827 HALYARD DRIVE PLYMOUTH MI 48170 0 1 0 0 V.P Global Sales & Marketing Common Stock 1763 D Common Stock 20000 I By Spouse Employee Stock Option (right to buy) 5.7 2012-09-04 2022-09-04 Common Stock 375 D Employee Stock Option (right to buy) 10.55 2013-09-03 2023-09-03 Common Stock 1000 D Employee Stock Option (right to buy) 6.72 2017-01-03 2027-01-03 Common Stock 20000 D The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. The option became fully exercisable on September 4, 2016 The option became exercisable as to 250 on each of September 3, 2014, September 3, 2015 and September 3, 2016 and the remaining 250 shares became exercisable on September 3, 2017. The option becomes exercisable in three equal annual installments beginning January 3,2018. /s/ Richard Van Valkenburg 2017-09-07 EX-24 2 rickvpowerofattorney.txt POWEROFATTORNEY POWER OF ATTORNEY For Executing Forms 3, 4 and 5 The undersigned hereby constitutes and appoints each of David L. Watza or Michelle O. Wright, acting singly, as his true and lawful attorney-in-fact to: 1.execute for and on behalf of the undersigned Forms 3, 4 and 5 in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder; and Securities Exchange Act of 1934 and the rules thereunder; and 2.do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete the execution of any such Form 3, 4 or 5 and the timely filing of such form with the United States Securities and Exchange Commission and any other person or authority. The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform all and every act and thing whatsoever requisite, necessary and proper to be done in the exercise of any of the rights and powers herein granted, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or his 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 above-named attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming any of the undersigneds responsibilities to comply with Section 16 of the Securities Exchange Act of 1934. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 28th day of August 2017. /s/ Richard J. Van Valkenburg Signature