- Statement of Changes in Beneficial Ownership (4)
2010年6月3日 - 5:42AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public
Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Kowalski Christine R
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2. Issuer Name
and
Ticker or Trading Symbol
ev3 Inc.
[
evvv
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Sr. VP, Operations
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(Last)
(First)
(Middle)
C/O EV3 INC., 3033 CAMPUS DRIVE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
5/31/2010
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(Street)
PLYMOUTH, MN 55441
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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5/31/2010
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A
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6667
(1)
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A
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$0
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26611
(2)
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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These shares represent a restricted stock grant under the ev3 Inc. Third Amended and Restated Incentive Plan and were issued to the reporting person pursuant to ev3's 2010 long-term equity grant guidelines that provide for broad-based annual performance recognition grants to employees. The number of shares issued was determined based primarily on a multiple of the reporting person's base salary as set forth in ev3's 2010 long-term equity grant guidelines and the $22.50 per share of ev3 common stock purchase price set forth in that certain Agreement and Plan of Merger dated as of June 1, 2010 among Covidien Group S.a.r.l., a Luxembourg company ("Parent"), and Parent's wholly-owned subsidiary, COV Delaware Corporation, a Delaware corporation. The restricted shares vest over time and are subject to forfeiture until vested. Vesting will be accelerated in the event the transactions contemplated in the foregoing merger agreement are consummated.
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(
2)
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Consists of 26,611 shares issued pursuant to restricted stock grants under the ev3 Inc. Third Amended and Restated 2005 Incentive Plan and still subject to forfeiture.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Kowalski Christine R
C/O EV3 INC.
3033 CAMPUS DRIVE
PLYMOUTH, MN 55441
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Sr. VP, Operations
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Signatures
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/s/ Kevin M. Klemz, attorney-in-fact
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6/2/2010
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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