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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 | ||||||||
Variable Prepaid Stk Purchase Agmt(Right & Oblig to sell) | (1) | 07/11/2005(1) | X(1) | 33,069 | (1) | (1) | Common Stock | 33,069 | (1) | 0 | I | Michael Jandernoa Trust (2) | |||
Var Prepaid Stk Purchase Agmt(Right & Oblig to Sell) | (1) | 07/11/2005(1) | X(1) | 33,108 | (1) | (1) | Common Stock | 33,108 | (1) | 0 | I | Michael Jandernoa Trust (2) | |||
Variable Prepaid Sk Purchase Agmt(Right & Oblig to Sell) | (3) | 07/11/2005(3) | X(3) | 716,767 | (3) | (3) | Common Stock | 716,767 | (1) | 0 | I | Michael Jandernoa Trust (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
JANDERNOA MICHAEL J BRIDGEWATER PLACE 333 BRIDGE STREET NW SUITE 800 GRAND RAPIDS, MI 49504 |
X |
Michael J. Jandernoa | 07/13/2005 | |
**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) | On 6/18/02 the reporting person, solely in his capacity of the Michael J.Jandernoa Trust ("Trust") entered into a Variable Prepaid Stock Purchase Agreement ("Agreement") relating to 66177 shares in 2 tranches of 33069 (Tranche No. 1)& 33108 (Tranche No. 2). The Trust's obligation to deliver shares pursuant to the Agreement was secured by a pledge of the covered shares. On settlement date, in accordance with a formula in the Agreement, the counterparty to Agreement took delivery of 28280 pledged shares from TR 1 & 28280 pledged shares from TR 2. The Trust retained the remaining 4789 shares from TR 1 and 4828 shares from TR 2, all of which shares are now free of the pledge. The formula used to determine the shares received by the counterparty was based on the closing price of Perrigo common stock on each of the 15 trading days preceding & including maturity date, which ranged from $13.65 to $14.79. |
(2) | Michael J. Jandernoa Trust of which the reporting person is the Trustee. |
(3) | On November 20, 2002, the reporting person, solely in his capacity of the Michael J. Jandernoa Trust ("Trust") entered into a Variable Prepaid Stock Purchase Agreement ("Agreement") relating to 716767 shares. The Trust's obligation to deliver shares pursuant to the Agreement was secured by a pledge of the covered shares. On the settlement date, in accordance with a formula in the Agreement, the counterparty to the Agreement took delivery of 654551 pledged shares. The Trust retained the remaining 62216 shares, which shares are now free of the pledge. The formula used to determine the shares received by the counterparty was based on the closing price of Perrigo common stock on each of the 15 trading days preceding and including the maturity date, which ranged from $13.65 to $14.79. |