Statement of Changes in Beneficial Ownership (4)
2016年8月25日 - 2:36AM
Edgar (US Regulatory)
FORM 4
[
X
]
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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OMB APPROVAL
OMB Number:
3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
LaRose Jeffrey
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2. Issuer Name
and
Ticker or Trading Symbol
HeartWare International, Inc.
[
HTWR
]
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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)
Chief Scientific Officer
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(Last)
(First)
(Middle)
C/O HEARTWARE INTERNATIONAL, INC., 500 OLD CONNECTICUT PATH
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3. Date of Earliest Transaction
(MM/DD/YYYY)
8/23/2016
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(Street)
FRAMINGHAM, MA 01701
(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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8/23/2016
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U
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12482
(1)
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D
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$58
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0
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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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Restricted Stock Unit
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(2)
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8/23/2016
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D
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2250
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(3)
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(3)
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Common Stock
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2250
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(3)
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0
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D
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Restricted Stock Unit
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(2)
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8/23/2016
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D
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3000
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(3)
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(3)
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Common Stock
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3000
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(3)
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0
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D
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Restricted Stock Unit
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(2)
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8/23/2016
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D
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1600
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(3)
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(3)
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Common Stock
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1600
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(3)
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0
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D
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Restricted Stock Unit
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(2)
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8/23/2016
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D
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2400
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(3)
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(3)
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Common Stock
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2400
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(3)
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0
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D
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Restricted Stock Unit
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(2)
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8/23/2016
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D
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3000
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(3)
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(3)
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Common Stock
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3000
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(3)
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0
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D
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Restricted Stock Unit
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(2)
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8/23/2016
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D
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1600
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(3)
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(3)
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Common Stock
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1600
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(3)
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0
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D
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Restricted Stock Unit
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(2)
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8/23/2016
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D
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1200
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(3)
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(3)
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Common Stock
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1200
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(3)
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0
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D
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Restricted Stock Unit
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(2)
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8/23/2016
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D
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3000
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(3)
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(3)
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Common Stock
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3000
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(3)
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0
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D
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Stock Option (right to buy)
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$33.49
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8/23/2016
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D
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5000
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(4)
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2/19/2026
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Common Stock
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5000
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(4)
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0
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D
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Explanation of Responses:
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(
1)
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Disposed of in a tender offer by Medtronic Acquisition Corp., a Delaware Corporation ("Purchaser") to acquire all of the outstanding shares of common stock of HeartWare International, Inc., a Delaware corporation ("HeartWare") for $58.00 per share pursuant to the terms of that certain Agreement and Plan of Merger, dated as of June 27, 2016, by and among HeartWare, Purchaser, and Medtronic, Inc., a Minnesota corporation (the "Merger Agreement"). All terms capitalized but not defined shall have the meaning given to them in the Merger Agreement.
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(
2)
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Each restricted stock unit represents a right to receive one share of HeartWare common stock.
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(
3)
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Pursuant to the Merger Agreement, each unvested restricted stock unit was automatically cancelled as of the Effective Time and converted into the right to receive an amount in cash equal to the product of (i) $58.00 multiplied by (ii) the number of shares of HeartWare common stock subject to such restricted stock unit as of immediately prior to the Effective Time (with any such restricted stock units that are subject to performance-based vesting being deemed earned assuming achievement of all performance milestones), less any required withholding of taxes.
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(
4)
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Pursuant to the Merger Agreement, each option that was outstanding and unexercised immediately prior to the Effective Time and for which the exercise price of such option was less than $58.00 per share, without regard to the extent vested or exercisable, was automatically canceled as of the Effective Time and converted into the right to receive a cash payment equal to the product of the excess of $58.00 over the exercise price of such option and the number of unexercised shares of HeartWare common stock subject to such option immediately prior to the Effective Time, less any required withholding of taxes. Each option for which, as of the Effective Time, the exercise price of such option was greater than $58.00 was automatically cancelled as of the Effective Time without any consideration being paid in respect thereof.
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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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LaRose Jeffrey
C/O HEARTWARE INTERNATIONAL, INC.
500 OLD CONNECTICUT PATH
FRAMINGHAM, MA 01701
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Chief Scientific Officer
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Signatures
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/s/ Larry Knopf as Attorney-in-Fact
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8/24/2016
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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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