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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Performance Vesting Restricted Stock Units | $ 0 | 08/28/2017 | A | V | 50,000 | (1) | (1) | Common Stock | 50,000 | $ 0 | 50,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SULLIVAN PATRICK J C/O INSULET CORPORATION 600 TECHNOLOGY PARK DRIVE, SUITE 200 BILLERICA, MA 01821 |
X | CEO and Chairman of the Board |
/s/ David Colleran, attorney-in-fact | 08/29/2017 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Represents a grant of 50,000 performance vesting restricted stock units ("PRSUs"), each of which represents a contingent right to receive one share of common stock. The PRSUs are subject to dual performance-based and time-based vesting requirements. The performance criteria is as follows: (i) for 15,000 of the PRSUs, the Company beginning to recognize revenue from direct operations in Europe, (ii) for 15,000 of the PRSUs, the Company recognizing certain cumulative revenue metrics from direct operations in Europe, and (iii) for 20,000 of the PRSUs, the Company completing certain manufacturing expansion activities. Each of the performance criteria may be satisfied during the performance period beginning on the grant date and ending on December 31, 2019. The time-based vesting requirements will be satisfied if Mr. Sullivan remains a service provider through the third anniversary of the grant date, provided that the time-based requirements are subject to earlier satisfaction under certain circumstances (including certain retirement scenarios) pursuant to the terms of Mr. Sullivan's existing employment agreement. |