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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 Options (Rights to Buy) | $ 27 | 01/19/2005 | A | 1,625 | 01/19/2006 | 01/19/2012 | Common Stock | 1,625 | $ 0 | 1,625 | D | ||||
Employee Stock Options (Rights to Buy) | $ 27 | 01/19/2005 | A | 1,625 | 01/19/2007 | 01/19/2012 | Common Stock | 1,625 | $ 0 | 1,625 | D | ||||
Employee Stock Options (Rights to Buy) | $ 27 | 01/19/2005 | A | 1,625 | 01/19/2008 | 01/19/2012 | Common Stock | 1,625 | $ 0 | 1,625 | D | ||||
Employee Stock Options (Rights to Buy) | $ 27 | 01/19/2005 | A | 1,625 | 01/19/2009 | 01/19/2012 | Common Stock | 1,625 | $ 0 | 1,625 | D | ||||
Restricted Stock Units | (1) | 01/19/2005 | A | 4,500 | 01/19/2009 | 01/19/2009 | Common Stock | 4,500 | $ 0 | 4,500 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HENSGEN HEINZ ULRICH PALL DEUTSCHLAND GMBH PHILIPP-REISS STRASSE 6 DREIEICH, 2M 63303 |
Group Vice President |
Mary Ann Bartlett as Attorney-in-Fact for Heinz Ulrich Hensgen | 01/21/2005 | |
**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) | The Units will vest and become convertible into shares of Common Stock of the Issuer on a one-for-one basis on the date shown in Column 6 provided the Reporting Person is still employed by the Issuer or a subsidiary on that date. If employment terminates sooner, the Units will be forfeited unless termination of employment occurs because of death, disability, retirement, or termination of employment without cause, in any of which events the Units may vest in whole or in part. |