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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) | $ 11.375 | 11/02/2004 | M | 38,000 | 01/02/2002 | 01/02/2011 | Common Stock | 38,000 | $ 0 | 0 | D | ||||
Employee Stock Option (right to buy) | $ 17.47 | 11/02/2004 | M | 29,332 | 01/02/2004 | 01/02/2013 | Common Stock | 29,332 | $ 0 | 58,668 (1) | D | ||||
Employee Stock Option (right to buy) | $ 18.1485 | 11/02/2004 | M | 42,064 | 01/02/2003 | 01/02/2012 | Common Stock | 42,064 | $ 0 | 24,000 | D | ||||
Employee Stock Option (right to buy) | $ 38.72 | 11/02/2004 | A(2) | 11,163 | 11/02/2004(3) | 01/02/2011(3) | Common Stock | 11,163 | $ 0 | 11,163 | D | ||||
Employee Stock Option (right to buy) | $ 38.72 | 11/02/2004 | A(2) | 19,715 | 11/02/2004(3) | 01/02/2012(3) | Common Stock | 19,715 | $ 0 | 19,715 | D | ||||
Employee Stock Option (right to buy) | $ 38.72 | 11/02/2004 | A(2) | 13,234 | 11/02/2004(3) | 01/02/2013(3) | Common Stock | 13,234 | $ 0 | 13,234 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HARRISON DAVID D 5500 WAYZATA BLVD. SUITE 800 GOLDEN VALLEY, MN 55416-1259 |
Executive Vice President, CFO |
David D Harrison | 11/04/2004 | |
**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 May 17, 2004, Pentair declared a 2-for-1 stock split in the form of a 100 percent stock dividend payable on June 8, 2004, to shareholders of record as of June 1, 2004. This previously reported stock option and exercise price have been adjusted to reflect the stock split. |
(2) | Employee reload stock option granted pursuant to the Pentair, Inc. Omnibus Stock Incentive Plan. |
(3) | Reload stock option becomes exercisable upon grant and expires on the same date as the original option grant. |