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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 | ||||||||
Stock Option (Right to Buy) | $ 27.37 | 05/13/2015 | A | 5,525 | (3) | 05/13/2025 | Common Stock | 5,525 | $ 0 | 5,525 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Fallon John A. C/O INSULET CORPORATION 600 TECHNOLOGY PARK DRIVE, SUITE 200 BILLERICA, MA 01821 |
X |
/s/ R. Anthony Diehl, attorney in fact | 05/18/2015 | |
**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) | The 4,039 restricted stock units vest 50% of the total units on April 30, 2016, 25% of the total units on April 30, 2017 and 25% of the total units on April 30, 2018, subject to continued service as a director or consultant. Vested shares will be delivered to the reporting person as soon as practicable following a vesting date. |
(2) | Includes 1,000 restricted stock units granted on June 3, 2013 which vest on April 30, 2016; and 2,000 restricted stock units granted on June 2, 2014, which vest 50% of the total units on April 30, 2016 and 50% of the total units on April 30, 2017, subject to continued service as a director or consultant. Vested shares will be delivered to the reporting person as soon as practicable following a vesting date. |
(3) | This option is subject to a three-year vesting period with 50% of the total award vesting on April 30, 2016, 25% of the total award vesting on April 30, 2017 and 25% of the total award vesting on April 30, 2018, subject to continued service as a director or consultant. |