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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 | ||||||||
Employee Stock Option (Right to Buy) | $ 24.6 | 11/07/2011 | A | 27,443 | (1) | 11/07/2021 | Common Stock | 27,443 | $ 0 | 27,443 | D | ||||
Restricted Stock Unit | (2) | 11/07/2011 | A | 9,248 | (3) | (3) | Common Stock | 9,248 | $ 0 | 9,248 | D | ||||
Restricted Stock Unit | (2) | 11/07/2011 | A | 4,820 (4) | (5) | (5) | Common Stock | 4,820 | $ 0 | 4,820 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Kuchenbrod Michael 1133 WESTCHESTER AVENUE C/O XYLEM INC. WHITE PLAINS, NY 10604 |
Senior Vice President |
/s/ Rina E. Teran, Assistant Corporate Secretary of Xylem Inc., by power of attorney for Michael Kuchenbrod | 11/09/2011 | |
**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) | These options vest in three equal annual installments beginning on November 7, 2012. |
(2) | Each restricted stock unit ("RSU") represents the right to receive the cash value of one share of Xylem Inc. common stock. |
(3) | Each of these RSUs vests on November 7, 2014, subject to early vesting in certain circumstances in connection with a separation of service or acceleration event. |
(4) | Reflects the conversion of the unvested portions of cash-settled total shareholder return ("TSR") awards previously granted by ITT Corporation into RSUs of Xylem Inc. in connection with the spin-off of Xylem Inc. from ITT Corporation. These RSUs will be settled in cash. |
(5) | 1,687 RSUs were awarded in respect of 2010 TSR awards and will vest on December 31, 2012. 3,133 RSUs were awarded in respect of 2011 TSR awards and will vest on December 31, 2013. |